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Individual

MICHAEL J. WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4001 OFFICE COURT DRIVER STE 102, SANTA FE, NM 87507
(505) 395-9437
(505) 930-5427
Mailing address
11 ROSEWOOD DR, HOWELL, NJ 07731-3414
(732) 966-0595

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
12/15/2023
Last updated
12/15/2023
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