Individual
DR. LARRY D WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., LMFT
Contact information
Practice address
7545 CENTURION PKWY, SUITE # 105, JACKSONVILLE, FL 32256-0579
(904) 642-2468
(904) 642-2469
Mailing address
2058 BEACH AVE, ATLANTIC BEACH, FL 32233-5935
(904) 372-7365
(904) 372-7365
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT1162
FL
Other
Enumeration date
10/12/2006
Last updated
01/29/2013
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