Individual
DR. JENNY F WAGSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC-S, NCC, ACS
Contact information
Practice address
817 W FRONT ST, LILLINGTON, NC 27546-9735
(910) 814-2197
(910) 814-2167
Mailing address
PO BOX 369, BUIES CREEK, NC 27506-0369
(910) 893-1633
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
S13702
NC
101YP2500X
Professional Counselor
0701005095
VA
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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