Individual
KIARA NICOLE WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1500 NORTH RITTER AVENUE, INDIANAPOLIS, IN 46219-3027
(317) 355-2560
(317) 355-2418
Mailing address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002180A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530
—
IN
Enumeration date
08/08/2007
Last updated
10/02/2014
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