Individual
MRS. AMANDA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
125 DOUGHTY ST, SUITE 190, CHARLESTON, SC 29403-5736
(843) 792-0484
Mailing address
67 PRESIDENT ST, MSC 861, CHARLESTON, SC 29425-8150
(843) 792-0484
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5209
SC
Other
Enumeration date
09/30/2010
Last updated
10/04/2010
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