Individual
MRS. KELLY WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
5165 BOWERS BROOK DR SW, LILBURN, GA 30047-5172
(505) 695-1613
Mailing address
5165 BOWERS BROOK DR SW, LILBURN, GA 30047-5172
(505) 695-1613
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CCHM0207621
NM
Other
Enumeration date
01/13/2014
Last updated
07/20/2020
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