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Individual
GLAVIS M WAGNER
Active
Individual
GLAVIS M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17-CRM-217
OR
175T00000X
Peer Specialist
THW000002415
OR
405300000X
Prevention Professional
Primary
17-CRM-217
OR
Other
Enumeration date
02/07/2018
Last updated
07/23/2020
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