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General NPI Number Information
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NPI Number | 1790961787
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Entity Type | Individual
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Provider Name | WILLIAM CHRISTOPHER WAGNER LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 746 9TH ST
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City | TELL CITY
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State | IN
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Zip | 47586-1711
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Country | US
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Telephone | 812-547-2933
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Fax |
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Provider Business Mailing Address
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Address Line | 746 9TH ST
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City | TELL CITY
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State | IN
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Zip | 47586-1711
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Country | US
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Telephone | 812-547-2933
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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 | 34004522A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000045A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 34004522A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34004522A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 34004522A
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License Number State | IN
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