Individual
MR. BENJAMIN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
3340 WOODBURN RD, ANNANDALE, VA 22003-1202
(703) 207-7826
(703) 280-9518
Mailing address
3340 WOODBURN RD, ANNANDALE, VA 22003-1202
(703) 207-7826
(703) 280-9518
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701004002
VA
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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