Doctor Name: | DR. SHANNON D MULLEN-MAGBALON |
NPI Number: | 1053640235 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY003406 |
Business Practice Address: | 229 Remington Ave Thomasville, GA - 317925599 |
Business Phone Number: | 2292003157 |
Business Fax Number: | |
Mailing Address: | Po Box 378, THOMASVILLE |
State: | GA |
Postal Code: | 317990378 |
Phone Number: | 2292003157 |
Fax Number: | |
NPI Enumeration Date: | 12/16/2009 |
NPI Last Update Date: | 12/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | PSY003406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |