Organization
MAGNOLIA FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN E TIRELLA BCBA, LBA (OWNER/DIRECTOR)
(571) 882-1879
Entity
Organization
Contact information
Practice address
2514 N DEARING ST, ALEXANDRIA, VA 22302-1807
(571) 882-1879
Mailing address
2514 N DEARING ST, ALEXANDRIA, VA 22302-1807
(571) 882-1879
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0133000432
VA
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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