Individual
MICHELE SUZANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
2900 CHAMBLEE TUCKER RD, BLD 8, STE 301, ATLANTA, GA 30341-4100
(678) 824-6590
(678) 824-6597
Mailing address
8075 MALL PKWY, STE 101-348, LITHONIA, GA 30038-6993
(678) 288-6550
(800) 609-0965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004260
GA
Other
Enumeration date
05/30/2011
Last updated
05/30/2011
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