Individual
MS. CAROLJEAN WAGENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LCAC
Contact information
Practice address
8300 SOUTH MERIDIAN STREET, INDIANAPOLIS, IN 46227-4943
(317) 881-8711
Mailing address
8300 SOUTH MERIDIAN STREET, INDIANAPOLIS, IN 46227-4943
(317) 881-8711
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001133A
IN
1041C0700X
Clinical Social Worker
Primary
34003291A
IN
Other
Enumeration date
03/29/2007
Last updated
02/13/2012
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