Individual
AMANDA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., ED.S., LMFT
Contact information
Practice address
3457 BROOK CROSSING DR, BRANDON, FL 33511-8181
(813) 767-8366
Mailing address
3457 BROOK CROSSING DR, BRANDON, FL 33511-8181
(813) 767-8366
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT2858
FL
Other
Enumeration date
04/27/2015
Last updated
04/27/2015
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