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Individual

SHANNON MARIE WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2310 E ATLANTIC BLVD BLDG 2, POMPANO BEACH, FL 33062-5251
(954) 990-7171
(954) 530-5992
Mailing address
2310 E ATLANTIC BLVD BLDG 2, POMPANO BEACH, FL 33062-5251
(954) 990-7171
(954) 530-5992

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SW16190
FL

Other

Enumeration date
05/06/2020
Last updated
05/06/2020
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