Phyliss Wagner
Professional Counselor Addiction Counselor (Substance Use Disorder)
107 Woodstock Dr
Avon Lake
, Ohio 44012-1622
Phyliss Wagner
Professional Counselor Addiction Counselor (Substance Use Disorder)
107 Woodstock Dr
Avon Lake
, Ohio 44012-1622
(440) 296-2050
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About
Features
Specialties
- Addiction Counselor (Substance Use Disorder)
- Professional Counselor
Languages spoken
- English
Location
First Address
- Phyliss Wagner
- 107 Woodstock Dr
- Avon Lake, OH
- Zip : 44012-1622
- Fax : (440) 296-2050
- Phone : (440) 989-4987
Second Address
- Phyliss Wagner
- 107 Woodstock Dr
- Avon Lake, OH
- Zip : 44012-1622
- Fax : (440) 246-0189
- Phone : (440) 296-2050
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.164771 | OH |
| N | 101YP2500X | Professional Counselor | E.2001993 | OH |
National Provider Identifier
| NPI | 1003325416 |
|---|---|
| Provider Name | Phyliss Wagner |
| First Address | Avon Lake, OH 44012-1622 |
| Second Address | Avon Lake, OH 44012-1622 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/09/2017 |
| Last Update Date | 12/03/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| CDCA.164771 | LICENSE (01) | OH |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.