Individual
MRS. KATHLEEN ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
145 EMERALD LN, FAYETTEVILLE, GA 30214-4234
(678) 871-5927
Mailing address
145 EMERALD LN, FAYETTEVILLE, GA 30214-4234
(678) 871-5927
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC006769
GA
Other
Enumeration date
07/09/2012
Last updated
05/14/2020
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