Individual
KATHERYN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 SCHOOL ST, PLYMOUTH, MA 02360-3964
(508) 830-1234
Mailing address
27 COLE ST, KINGSTON, MA 02364-1748
(781) 585-1075
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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