| NPI | 1184744955 |
|---|---|
| Former Name | TERESA ANN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00970) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI 206) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-08-02 |