Individual
MR. ROBERT BRUCE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
333 N 2ND ST, SUITE 305, NILES, MI 49120-2258
(269) 449-8951
Mailing address
333 N 2ND ST, SUITE 305, NILES, MI 49120-2258
(269) 449-8951
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401000453
MI
Other
Enumeration date
01/24/2007
Last updated
07/08/2007
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