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Individual
MR. MICHAEL WANDERS
Active
Individual
MR. MICHAEL WANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW,LADC1
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1199
MA
104100000X
Social Worker
3032220
MA
Other
Enumeration date
12/28/2006
Last updated
12/30/2015
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