Provider Demographics
NPI:1235744756
Name:WAGNER, TIANNA (MS, LPCMH, NCC)
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3610
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-3610
Mailing Address - Country:US
Mailing Address - Phone:302-635-0003
Mailing Address - Fax:
Practice Address - Street 1:8 THE GRN STE 8216
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:302-635-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional