Individual
DENISE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, BS
Contact information
Practice address
29650 BRADLEY RD STE B, MENIFEE, CA 92586-6521
(951) 430-9247
Mailing address
30141 ANTELOPE RD STE D726, MENIFEE, CA 92584-7001
(196) 318-6116
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171400000X
Health & Wellness Coach
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
06/12/2023
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