Provider Demographics
NPI:1457507865
Name:WAGNER, CRISTINA JYNEL (MS)
Entity Type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:JYNEL
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 WESLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4179
Mailing Address - Country:US
Mailing Address - Phone:903-455-9090
Mailing Address - Fax:
Practice Address - Street 1:2718 WESLEY ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4179
Practice Address - Country:US
Practice Address - Phone:903-455-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor