Individual
AMY S WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, LMFT
Contact information
Practice address
3544 EDGEWATER DR, ORLANDO, FL 32804-2922
(407) 291-8009
Mailing address
3544 EDGEWATER DR, ORLANDO, FL 32804-2922
(407) 291-8009
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
17790
FL
106H00000X
Marriage & Family Therapist
3809
FL
Other
Enumeration date
08/29/2017
Last updated
07/21/2022
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