| Doctor Name: | MS. TERESA A WAGNER |
| NPI Number: | 1184744955 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 206 |
| Business Practice Address: | 65-1206 Mamalahoa Hwy Kamuela, HI - 967437303 |
| Business Phone Number: | 8084949540 |
| Business Fax Number: | 8088850716 |
| Mailing Address: | 65-1206 Mamalahoa Hwy, KAMUELA |
| State: | HI |
| Postal Code: | 967437303 |
| Phone Number: | 8084949540 |
| Fax Number: | 8088850716 |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 05/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |