Individual
AMY R WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D., LCSW, BCABA
Contact information
Practice address
6505 SHILOH RD, SUITE 100, ALPHARETTA, GA 30005-8405
(678) 648-7644
(678) 648-7479
Mailing address
6505 SHILOH RD, SUITE 100, ALPHARETTA, GA 30005-8405
(678) 648-7644
(678) 648-7479
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
CSW004454
GA
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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