Susan Wagner LLC
Community/Behavioral Health in Irmo, SC. Organization (NPI-2).
NPI number1750133641
StatusActive
Last updated in NPPESApr 3, 2024
Details
- NPI
- 1750133641
- Entity type
- Organization (NPI-2)
- Legal business name
- Susan Wagner LLC
- Organization subpart
- No
- Enumeration date
- Apr 3, 2024
- Certification date
- Apr 3, 2024
- Last updated
- Apr 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
114 Glen Ridge CtIrmo, SC 29063-8494
Phone 803-240-5448
Mailing address
114 Glen Ridge CtIrmo, SC 29063-8494
Phone 803-240-5448
Authorized official
Susan F Wagner
Licensed Professional Counselor
8032405448
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