Individual
ROBIN M WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LCDC
Contact information
Practice address
5005 COLLEYVILLE BLVD STE 201, COLLEYVILLE, TX 76034-5864
(817) 851-6589
Mailing address
5005 COLLEYVILLE BLVD STE 201, COLLEYVILLE, TX 76034-5864
(817) 851-6589
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12224
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12224
COUNSELING - ADDICTION
TX
Enumeration date
12/20/2022
Last updated
12/20/2022
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