Organization
ROSEBURG COUNSELING & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY LOUISE WAGNER LCSW (OWNER)
(541) 579-8100
Entity
Organization
Contact information
Practice address
251 NE GARDEN VALLEY BLVD STE B, ROSEBURG, OR 97470-2085
(541) 579-8100
Mailing address
251 NE GARDEN VALLEY BLVD STE B, ROSEBURG, OR 97470-2085
(541) 579-8100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7525
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11905531
CAQH
OR
Enumeration date
08/07/2018
Last updated
08/07/2018
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