Organization
MAGNOLIA EDUCATIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA LONGINO PHD (OWNER)
(601) 497-1413
Entity
Organization
Contact information
Practice address
4403 DIXIE HILL RD APT 205, FAIRFAX, VA 22030-9061
(601) 497-1413
Mailing address
12587 FAIR LAKES CIR # 267, FAIRFAX, VA 22033-3822
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/27/2020
Last updated
08/27/2020
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