Individual
MR. MARK WAGEMAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC 5042
Contact information
Practice address
402B ADAMSON SQ, SUITE 11, CARROLLTON, GA 30117-3214
(404) 580-6684
Mailing address
PO BOX 1196, CARROLLTON, GA 30112-0022
(404) 580-6684
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC5042
GA
Other
Enumeration date
03/09/2007
Last updated
08/05/2009
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