| Susan Wagner Llc | |
|
114 Glen Ridge Ct Irmo SC 29063-8494 | |
| (803) 240-5448 | |
| Not Available |
| Full Name | Susan Wagner Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 114 Glen Ridge Ct, Irmo, South Carolina |
| Authorized Official Name and Position | Susan F Wagner (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 8032405448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan Wagner Llc 114 Glen Ridge Ct Irmo SC 29063-8494 Ph: (803) 240-5448 | Susan Wagner Llc 114 Glen Ridge Ct Irmo SC 29063-8494 Ph: (803) 240-5448 |
| NPI Number | 1750133641 |
|---|---|
| Provider Enumeration Date | 04/03/2024 |
| Last Update Date | 04/03/2024 |
| Certification Date | 04/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750133641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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