KEITH HAROLD WAGONER

SACRAMENTO, CA
NPI1114268588
Former NameKEITH HAROLD THIGPEN
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy171M00000X Case Manager/Care Coordinator
Additional Taxonomies101Y00000X Counselor
(Licence: CA  A022760416)
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2013-03-11
Last Update Date2024-08-27
Business Address
KEITH HAROLD WAGONER Counselor
2150 STOCKTON BLVD
SACRAMENTO, CA 95817-1337
Phone number: 916-875-1000
Mailing Address
KEITH HAROLD WAGONER Counselor
2150 STOCKTON BLVD
SACRAMENTO, CA 95817-1337
Phone number: 916-875-1000