Individual
JEFFREY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
2865 LOGAN AVE, SAN DIEGO, CA 92113-2411
(619) 232-4357
Mailing address
2865 LOGAN AVE, SAN DIEGO, CA 92113-2411
(619) 232-4357
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11955
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37378100
—
CA
Enumeration date
08/25/2014
Last updated
10/30/2025
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