Doctor Name: | MR. WILLIAM DOUGLAS WAGNER |
NPI Number: | 1043594963 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LCSW |
License Number: | 356 |
Business Practice Address: | 2139 Palm Ct North Port, FL - 342875724 |
Business Phone Number: | 8599790160 |
Business Fax Number: | |
Mailing Address: | 2139 Palm Ct, NORTH PORT |
State: | FL |
Postal Code: | 342875724 |
Phone Number: | 8599790160 |
Fax Number: | |
NPI Enumeration Date: | 10/11/2011 |
NPI Last Update Date: | 10/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 356 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |