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1760172688
KENYADA MARIE WAGONER
RIVERSIDE, CA
NPI
1760172688
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: CA 114731)
Enumeration Date
2023-05-12
Last Update Date
2023-05-12
Business Address
KENYADA MARIE WAGONER LCSW
3939 13TH ST
RIVERSIDE, CA 92501-3505
Phone number: 951-214-5071
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Mailing Address
KENYADA MARIE WAGONER LCSW
315 E ESPLANADE AVE # 1581
SAN JACINTO, CA 92583-5102
Phone number: 951-214-5071
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