Individual
AMANDA KAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
(404) 417-1540
Mailing address
1670 CLAIRMONT ROAD, DECATUR, GA 30033
(404) 321-6111
(404) 417-1540
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004326
GA
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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