Individual
MRS. PAMELA LOU WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
17301 STATESVILLE RD, CORNELIUS, NC 28031-9353
(704) 892-8005
Mailing address
20200 FLORAL LN, CORNELIUS, NC 28031-9745
(704) 892-5390
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6531
NC
Other
Enumeration date
04/09/2008
Last updated
04/09/2008
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