Organization
MOSAIC PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON MULLEN MAGBALON PSYCHOLOGIST (OWNER)
(229) 233-8009
Entity
Organization
Contact information
Practice address
229 REMINGTON AVE, THOMASVILLE, GA 31792-5522
(229) 233-8009
(229) 233-8037
Mailing address
PO BOX 378, THOMASVILLE, GA 31799-0378
(229) 233-8009
(229) 233-8037
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY003406
GA
103T00000X
Psychologist
PSY003712
GA
1041C0700X
Clinical Social Worker
LCSW004523
GA
106H00000X
Marriage & Family Therapist
LMFT001440
GA
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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