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Mark T Wagner, PHD

Psychologist in Charleston, SC. Individual provider (NPI-1).

NPI number1346277142
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1346277142
Entity type
Individual (NPI-1)
Name
Mark T Wagner
Credential
PHD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 27, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103T00000X Psychologist536SCYes

Practice location

171 Ashley Ave
Charleston, SC 29425-0001

Phone 843-792-1414

Mailing address

Po Box 751461
Charlotte, NC 28275-1461

Phone 843-792-6200

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