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General NPI Number Information
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NPI Number | 1649920661
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Entity Type | Individual
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Provider Name | ELIZABETH WAGNER
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 355 OLD GLENWOOD ROAD
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City | MARION
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State | NC
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Zip | 28752
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Country | US
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Telephone | 828-803-6375
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LONG SHOALS RD B769
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City | ARDEN
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State | NC
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Zip | 28704
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Country | US
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Telephone | 845-544-3041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C019151
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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