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General NPI Number Information
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NPI Number | 1881996668
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Entity Type | Individual
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Provider Name | SUSAN FRANCIS WAGNER LPC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 7511 SAINT ANDREWS RD SUITE 3
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City | IRMO
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State | SC
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Zip | 29063-2894
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Country | US
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Telephone | 803-240-5448
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Fax | 803-407-3919
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Provider Business Mailing Address
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Address Line | 114 GLEN RIDGE CT
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City | IRMO
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State | SC
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Zip | 29063-8494
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Country | US
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Telephone | 803-240-5448
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Fax | 803-407-3919
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5206
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License Number State | SC
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