Individual
COURTNEY CIMONE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
442 AMBER ST, BROOKLYN, NY 11208-5284
(757) 310-3039
Mailing address
201 W 24TH ST UNIT 222, NORFOLK, VA 23517-1364
(757) 310-3039
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
011453
NY
Other
Enumeration date
06/29/2021
Last updated
06/29/2021
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