Individual
KIM A WAGNER-EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC-A, LCAS-A
Contact information
Practice address
163 STRATFORD CT, WINSTON SALEM, NC 27103-1836
(336) 448-4123
Mailing address
341 LUCINDA LN, KERNERSVILLE, NC 27284-9325
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-22340
NC
101YP2500X
Professional Counselor
Primary
A12831
NC
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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