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1548918832
KATHRYN BEATRICE WAGONER
FAIRFIELD, CA
NPI
1548918832
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-03-15
Last Update Date
2022-03-15
Business Address
KATHRYN BEATRICE WAGONER
609 JEFFERSON ST
FAIRFIELD, CA 94533-6293
Phone number: 707-399-9190
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Mailing Address
KATHRYN BEATRICE WAGONER
1812 SAN JOSE DR
ANTIOCH, CA 94509-4136
Phone number: 925-594-0786
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