Individual
AMAYA NICOLE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 VALLEY DR, VALPARAISO, IN 46383-2518
(219) 323-3311
Mailing address
3256 MAY ST, PORTAGE, IN 46368-4198
(219) 252-4440
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88003027A
IN
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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