Individual
AMY DANIELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
523 DIXIE ST STE 5, CARROLLTON, GA 30117-3870
(470) 347-7980
Mailing address
346 KRAMER ST, CARROLLTON, GA 30117-3708
(404) 713-7313
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001669
GA
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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