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NPI Code Detail

MEDICARE: MR. DEAN WAGENBRENNER LAPC

MEDICARE: MR. DEAN WAGENBRENNER LAPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorAPC003126GA

General Provider Information

NPI Number : 1639574767
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEAN WAGENBRENNER LAPC
Provider Business Mailing Address
First Line : 690 COURTENAY DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3421
Country : US
Telephone Number : 404-875-4551
Fax Number :
Provider Business Practice Location Address
First Line : 690 COURTENAY DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3421
Country : US
Telephone Number : 404-875-4551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2014
Last Update Date : 10/31/2014

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Directions to “ MR. DEAN WAGENBRENNER LAPC” Practice Location

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