Provider Demographics
NPI:1871079244
Name:MGG COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MGG COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:GAULDEN
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-915-4968
Mailing Address - Street 1:3565 LORNA RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-915-4968
Mailing Address - Fax:
Practice Address - Street 1:3565 LORNA RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-5246
Practice Address - Country:US
Practice Address - Phone:205-915-4968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0601-1666C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty