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Individual
MR. WILLIAM WAGNER
Active
Individual
MR. WILLIAM WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC4481
MD
101YP2500X
Professional Counselor
LC4481
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC4481
MD LICENSE LC4481
MD
Enumeration date
03/25/2013
Last updated
03/25/2013
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