| NPI | 1235417601 |
|---|---|
| Former Name | EMILY ALEXANDRA WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW60929) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2014-06-05 |