Individual
KATHLEEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1332 PICKENS ST, COLUMBIA, SC 29201-3430
(803) 771-4367
(803) 771-4160
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 217-0026
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9909
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LW1012
—
SC
Enumeration date
08/21/2013
Last updated
02/27/2014
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