Organization
MAGNOLIA PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY RABENSTEIN DONOHOE PSYD (OWNER)
(843) 284-6389
Entity
Organization
Contact information
Practice address
1124 PARK WEST BLVD STE 202, MT PLEASANT, SC 29466-7158
(843) 284-6389
Mailing address
1124 PARK WEST BLVD STE 202, MT PLEASANT, SC 29466-7158
(843) 284-6389
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1541
STATE LICENSE
SC
Enumeration date
05/03/2019
Last updated
06/11/2019
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