Individual
MRS. ERICA WESTHART VAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
124 MALLARD ST, GREENVILLE, SC 29601
(864) 241-1040
Mailing address
119 LINDA LANE, EASLEY, SC 29642-9495
(803) 238-7369
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301100
—
SC
Enumeration date
11/14/2006
Last updated
03/31/2008
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