Individual
MR. DAVID MICHAEL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
8335 40TH AVE N, ST PETERSBURG, FL 33709-3934
(727) 344-0315
(727) 344-0315
Mailing address
8335 40TH AVE N, ST PETERSBURG, FL 33709-3934
(727) 344-0315
(727) 344-0315
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MH1455
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH1455
LMHC LICENSE NUMBER
FL
Enumeration date
11/30/2006
Last updated
07/08/2007
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