Individual
C. ELISKA WAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4105 KIRKMAN ST, LAKE CHARLES, LA 70607-4603
(337) 475-8022
Mailing address
1765 N CLAIBORNE ST, SULPHUR, LA 70663-1154
(337) 475-8719
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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