Individual
MELISSA R WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
310 W THIRD AVE, GASTONIA, NC 28052-4004
(704) 868-8644
Mailing address
2015 DONEGAL CT, GASTONIA, NC 28054-6702
(980) 474-0117
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25261
NC
Other
Enumeration date
02/03/2019
Last updated
02/08/2025
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