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1669030631
JESSE WAGNER
SANTA CRUZ, CA
NPI
1669030631
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-06-04
Last Update Date
2019-06-04
Business Address
JESSE WAGNER
380 ENCINAL ST STE 200
SANTA CRUZ, CA 95060-2178
Phone number: 831-469-1700
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Mailing Address
JESSE WAGNER
380 ENCINAL ST STE 200
SANTA CRUZ, CA 95060-2178
Phone number: 831-469-1700
Copy
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