Individual
DR. DESTINY M WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
306 SAN PABLO ST SE, ALBUQUERQUE, NM 87108
(505) 272-0415
Mailing address
306 SAN PABLO ST SE, ALBUQUERQUE, NM 87108-3167
(505) 272-0415
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY1566
NM
Other
Enumeration date
07/20/2016
Last updated
07/05/2023
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