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General NPI Number Information
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NPI Number | 1659986859
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Entity Type | Individual
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Provider Name | SARAH WAGNER LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 2416A CENTRAL AVE STE D
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City | ALAMEDA
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State | CA
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Zip | 94501-4516
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Country | US
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Telephone | 510-219-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 1178 BROADWAY # B
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City | ALAMEDA
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State | CA
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Zip | 94501-5344
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Country | US
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Telephone | 510-219-5412
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 139438
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License Number State | CA
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