Individual
LISA DONETTE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
5420 DASHWOOD DR, STE 210, HOUSTON, TX 77081-5357
(713) 839-9898
(713) 839-9494
Mailing address
7619 PORTAL DR, HOUSTON, TX 77071-1828
(713) 995-9347
(713) 995-9347
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09909
SOCIAL WORK LICENSE
TX
01
—
1649384991
NPI
TX
05
—
180057501
—
TX
05
—
180057502
—
TX
Enumeration date
06/23/2008
Last updated
06/23/2008
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