Individual
DARRIN WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
363 HORSESHOE FARM RD, PEMBROKE, VA 24136-3471
(540) 626-7520
Mailing address
363 HORSESHOE FARM RD, PEMBROKE, VA 24136-3471
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701003867
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010281547
—
VA
Enumeration date
08/20/2006
Last updated
03/04/2010
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