Individual
MARK E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLADC
Contact information
Practice address
900 W NORFOLK AVE, NORFOLK, NE 68701-5006
(402) 370-3140
(402) 370-3373
Mailing address
900 W NORFOLK AVE, NORFOLK, NE 68701-5006
(402) 370-3140
(402) 370-3373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-1144
NE
Other
Enumeration date
05/16/2012
Last updated
07/14/2014
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