Healthcare Provider Details

I. General information

NPI: 1619674017
Provider Name (Legal Business Name): MICHELLE MEGAN WAGAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

IV. Provider business mailing address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax: 810-215-1334
Mailing address:
  • Phone: 517-492-0517
  • Fax: 810-215-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: