Individual
MR. ROBERT W WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
105 GREENCASTLE RD, SUITE B, TYRONE, GA 30290-2937
(770) 486-1011
Mailing address
105 GREENCASTLE RD, SUITE B, TYRONE, GA 30290-2937
(770) 757-7602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
003153
GA
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
05/04/2006
Last updated
12/26/2007
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