Individual
CHAVONNE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1100 EATON AVE, HAMILTON, OH 45013-1403
(513) 499-5266
Mailing address
28 DANIELLE CT, HAMILTON, OH 45013-5014
(513) 499-5266
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.162685
OH
101YP2500X
Professional Counselor
Primary
E.2303947
OH
Other
Enumeration date
01/11/2018
Last updated
10/12/2024
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