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Organization
MARY L. WAGNER LLC
Active
Organization
MARY L. WAGNER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY L. WAGNER LCSW, LLC (OWNER)
(210) 821-6464
Entity
Organization
Contact information
Practice address
313 ENCINO AVENUE, SAN ANTONIO, TX 78209
(210) 821-6464
Mailing address
313 ENCINO AVENUE, SAN ANTONIO, TX 78209
(210) 821-6464
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07873
TX
Other
Enumeration date
09/17/2009
Last updated
02/22/2010
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