| Magnolia Counseling Llc | |
|
11 High St Ste 202 Suffield CT 06078-2125 | |
| (860) 668-1444 | |
| (860) 668-1446 |
| Full Name | Magnolia Counseling Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11 High St Ste 202, Suffield, Connecticut |
| Authorized Official Name and Position | Anna Davenport (LICENSED MARITAL & FAMILY THERAPIST) |
| Authorized Official Contact | 8606681444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Counseling Llc 11 High St Ste 202 Suffield CT 06078-2125 Ph: (860) 668-1444 | Magnolia Counseling Llc 11 High St Ste 202 Suffield CT 06078-2125 Ph: (860) 668-1444 |
| NPI Number | 1922435593 |
|---|---|
| Provider Enumeration Date | 09/27/2013 |
| Last Update Date | 12/16/2023 |
| Certification Date | 12/16/2023 |
| Medicare PECOS PAC ID | 8527403609 |
|---|---|
| Medicare Enrollment ID | O20240228002606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922435593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 000724 (Connecticut) | Primary |
| Provider Name | Anna C Davenport |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689942336 PECOS PAC ID: 2163867243 Enrollment ID: I20240228002666 |
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