Individual
WILLIAM CHRISTOPHER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
746 9TH ST, TELL CITY, IN 47586-1711
(812) 547-2933
Mailing address
746 9TH ST, TELL CITY, IN 47586-1711
(812) 547-2933
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
34004522A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000045A
IN
101YM0800X
Mental Health Counselor
34004522A
IN
1041C0700X
Clinical Social Worker
34004522A
IN
106H00000X
Marriage & Family Therapist
34004522A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34004522A
LICENSE
IN
01
—
87000045A
LICENSE
IN
Enumeration date
01/21/2008
Last updated
10/11/2012
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