Individual
NANCY ELIZABETH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW LISAC
Contact information
Practice address
2408 E PECOS RD, PHOENIX, AZ 85048-8272
(480) 329-9688
(480) 329-9688
Mailing address
10204 BODE ST STE B, PLAINFIELD, IL 60585-9813
(855) 241-7160
(954) 324-8354
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-11062
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-11534
AZ
Other
Enumeration date
03/01/2007
Last updated
05/18/2021
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