| NPI | 1679985873 |
|---|---|
| Former Name | HEATHER JANE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6301016125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401014264) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2019-04-23 |