Individual
ELIZABETH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
872 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5927
(505) 867-2383
(505) 867-7293
Mailing address
782 TRAMWAY PL NE APT C, ALBUQUERQUE, NM 87122-1614
(505) 867-2383
(505) 867-7293
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
008010
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
75129825
—
NM
Enumeration date
08/05/2006
Last updated
05/02/2008
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