The Magnolia Group Center for Health and Wellness

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THE MAGNOLIA GROUP CENTER FOR HEALTH AND WELLNESS

Doing business as

The Magnolia Group

Practice address

1233 Mall Dr
North Chesterfield, VA 23235-4737

Phone

(804) 625-9868

NPI assigned

Mar 21, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lakesha Broussard

Title

Director of Services

Phone

(804) 901-3458

Specialties & licenses 5

Addresses

Other names 1

• The Magnolia Group Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1962104034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8132 FOREST HILL AVE STE A",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232353265",
            "telephone_number": "804-901-3458",
            "fax_number": "866-781-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 MALL DR",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232354737",
            "telephone_number": "804-625-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MAGNOLIA GROUP CENTER FOR HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-21",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "LAKESHA",
        "authorized_official_title_or_position": "DIRECTOR OF SERVICES",
        "authorized_official_telephone_number": "804-901-3458"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Magnolia Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.