Provider Demographics
NPI:1073204160
Name:WAGUESPACK, CECI (LCSW)
Entity Type:Individual
Prefix:
First Name:CECI
Middle Name:
Last Name:WAGUESPACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:WAGUESPACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:246 GUAVA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5030
Mailing Address - Country:US
Mailing Address - Phone:225-571-9188
Mailing Address - Fax:
Practice Address - Street 1:7914 WRENWOOD BLVD STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1773
Practice Address - Country:US
Practice Address - Phone:225-571-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical