Organization
MAGNOLIA WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GIZELLE E TIRCUIT-POSEY LPC (OWNER)
(860) 439-1300
Entity
Organization
Contact information
Practice address
302 STATE ST, SUITE 201, NEW LONDON, CT 06320-2310
(860) 439-1300
Mailing address
302 STATE ST, SUITE 201, NEW LONDON, CT 06320
(860) 439-1300
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
002923
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CBHP007958
—
CT
Enumeration date
03/24/2017
Last updated
03/24/2017
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