Doctor Name: | MS. MARY ABIGAIL WAGNER |
NPI Number: | 1518050731 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | |
Business Practice Address: | 1700 Education Ave Punta Gorda, FL - 339506222 |
Business Phone Number: | 9416398300 |
Business Fax Number: | 9417648114 |
Mailing Address: | 349 Sea Grape Rd, VENICE |
State: | FL |
Postal Code: | 342931627 |
Phone Number: | 9416398300 |
Fax Number: | 9417648114 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 12/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |