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General NPI Number Information
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NPI Number | 1801265624
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE MCCANN WAGNER MA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 19729 170TH AVE NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-7059
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Country | US
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Telephone | 254-448-0132
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Fax |
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Provider Business Mailing Address
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Address Line | 9805 NE 116TH ST # 7496
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City | KIRKLAND
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State | WA
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Zip | 98034-4245
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Country | US
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Telephone | 254-448-0132
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC60691352
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License Number State | WA
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