Individual
DR. GEORGE LANE WAGAMAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
100 EUROPA DR, CHAPEL HILL, NC 27517-2357
(919) 929-1227
(919) 968-2575
Mailing address
7332 CAPULIN CREST DR, APEX, NC 27539-4106
(919) 803-6393
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
182
WV
103TB0200X
Cognitive & Behavioral Psychologist
182
WV
103TC0700X
Clinical Psychologist
182
WV
103TC1900X
Counseling Psychologist
182
WV
103TF0200X
Forensic Psychologist
182
WV
103TH0100X
Health Service Psychologist
182
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001712519
BCBS MTN STATE
WV
05
—
9205024000
—
WV
Enumeration date
11/06/2006
Last updated
03/01/2010
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