Individual
GINNA THERESE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
1118 LIGHT ST STE 200, BALTIMORE, MD 21230-4152
(667) 600-2870
(667) 600-4038
Mailing address
1118 LIGHT ST STE 200, BALTIMORE, MD 21230-4152
(667) 600-2870
(667) 600-4038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16987
MD
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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