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1659963502
LISA FAE WAGNER
AGOURA HILLS, CA
NPI
1659963502
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: CA 40867)
Enumeration Date
2021-02-10
Last Update Date
2021-02-10
Business Address
LISA FAE WAGNER
29532 BERTRAND DR
AGOURA HILLS, CA 91301-4100
Phone number: 310-480-1719
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Mailing Address
LISA FAE WAGNER
29532 BERTRAND DR
AGOURA HILLS, CA 91301-4100
Phone number: 310-480-1719
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