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Individual
JOAN M WAGNER
Active
Individual
JOAN M WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCSW, CAP, CAC, LMSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
104100000X
Social Worker
118122
IA
1041C0700X
Clinical Social Worker
Primary
PCSW-1099
WY
Other
Enumeration date
07/25/2019
Last updated
02/09/2025
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