Individual
MR. JEFFRIE L WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MFT, CSAC
Contact information
Practice address
46-050 KONANE PL, KANEOHE, HI 96744-6121
(808) 247-7962
Mailing address
PO BOX 628, KANEOHE, HI 96744-0628
(808) 247-7962
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
127
HI
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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