Individual
BENJAMIN KENT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC-MHSP
Contact information
Practice address
4012 FORT HENRY DR, KINGSPORT, TN 37663-2028
(423) 430-9687
Mailing address
1216 SEMINOLE DR APT 5, JOHNSON CITY, TN 37604-7154
(423) 470-4683
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7325
TN
101YP2500X
Professional Counselor
7325
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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