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1013415199
SAMANTHA BROOKE WAGNER
OCEANSIDE, CA
NPI
1013415199
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-01-24
Last Update Date
2018-01-24
Business Address
SAMANTHA BROOKE WAGNER
3230 WARING CT STE A
OCEANSIDE, CA 92056-4509
Phone number: 760-305-7528
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Mailing Address
SAMANTHA BROOKE WAGNER
3230 WARING CT STE A
OCEANSIDE, CA 92056-4509
Phone number: 760-305-7528
Copy
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