| NPI | 1790252609 |
|---|---|
| Former Name | SHALANA MICHELLE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60834738) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60834738) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-12-19 |