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Individual
MR. MATTHEW WAGNER
Active
Individual
MR. MATTHEW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CAADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0212
GA
101YP2500X
Professional Counselor
Primary
9583
GA
Other
Enumeration date
10/29/2013
Last updated
11/01/2018
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