Individual
IMANI TACUMA WAGSTAFF I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MUSTARD ST, ROCHESTER, NY 14609-6980
(585) 256-7500
Mailing address
1 MUSTARD ST, ROCHESTER, NY 14609-6980
(585) 256-7500
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
12/29/2017
Last updated
01/11/2021
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