Individual
DR. AUDRA WAGAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9229 UNIVERSITY BLVD, BLDG F, SUITE 2A, NORTH CHARLESTON, SC 29406
(843) 789-6400
Mailing address
9229 UNIVERSITY BLVD, BLDG F, SUITE 2A, NORTH CHARLESTON, SC 29406
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1481
SC
Other
Enumeration date
11/02/2017
Last updated
07/26/2018
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