Individual
MR. MATTHEW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CAADC
Contact information
Practice address
545 N MCDONOUGH ST STE 212, DECATUR, GA 30030-3310
(770) 766-8128
Mailing address
545 N MCDONOUGH ST STE 212, DECATUR, GA 30030-3310
(770) 766-8128
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0212
GA
101YP2500X
Professional Counselor
Primary
9583
GA
Other
Enumeration date
10/29/2013
Last updated
11/01/2018
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