# GLAVIS M WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1720587553
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 17-CRM-217 | OR | — |
| 175T00000X | Peer Specialist | THW000002415 | OR | — |
| 405300000X | Prevention Professional | 17-CRM-217 | OR | Yes |

## Other

- **Enumeration date:** 02/07/2018
- **Last updated:** 07/23/2020