Individual
CHRISTINA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LCPC
Contact information
Practice address
1590 S MILWAUKEE AVE STE 224, LIBERTYVILLE, IL 60048-3785
(224) 424-0104
Mailing address
120 EAGLE POINT RD, FOX LAKE, IL 60020-1716
(847) 489-1818
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
180010700
IL
Other
Enumeration date
07/31/2012
Last updated
03/14/2017
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