Individual
TONYA LAVON WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
6512 RONALD RD APT T1, CAPITOL HEIGHTS, MD 20743-4481
(202) 819-3316
Mailing address
4733 W BRADDOCK RD APT 101, ALEXANDRIA, VA 22311-4733
(202) 819-3316
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC12354
MD
Other
Enumeration date
09/15/2021
Last updated
06/01/2023
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