Individual
DIANNE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 E MAIN ST, ROCKAWAY, NJ 07866-3614
(973) 229-3198
Mailing address
8 RESERVOIR RD, LAKE HOPATCONG, NJ 07849-1712
(973) 663-1303
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37CA000098200
NJ
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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