Individual
DONNA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
3517 BRANDON AVE SW, ROANOKE, VA 24018-1523
(540) 981-1102
Mailing address
301 ELM AVE SW, ROANOKE, VA 24016-4001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701006680
VA
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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