Individual
ALLISON JADE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
124 N COURT ST, FREDERICK, MD 21701-6614
(301) 304-7108
Mailing address
222 S RALEIGH ST, MARTINSBURG, WV 25401-2637
(304) 671-5109
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP9945
MD
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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