Individual
MS. DIANE MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608
(352) 376-1611
Mailing address
340 SW 62ND BLVD, #3, GAINESVILLE, FL 32607
(352) 331-0385
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
01216
IA
Other
Enumeration date
07/18/2006
Last updated
07/08/2007
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