Individual
MRS. KRISTI DEANNA WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
UNIT 6 MEADOW LANE, CENTRAL LA STATE HOSPITAL - RED RIVER TREATMENT CENTER, PINEVILLE, LA 71360
(318) 484-6609
(318) 487-5703
Mailing address
417 HIGHWAY 115, DEVILLE, LA 71328
(318) 466-1088
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
733
LA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
10/04/2006
Last updated
10/31/2024
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