| NPI | 1902191851 |
|---|---|
| Other Name | MARY CLAIRE WAGUESPACK (FENTON) |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 5014) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2015-06-15 |