Provider Demographics
NPI:1760609770
Name:WAGGONER, HELEN RAMONA (MA, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:RAMONA
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:MA, LCDC
Other - Prefix:MRS
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:WAGGONER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,LCDC
Mailing Address - Street 1:2505 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1120
Practice Address - Country:US
Practice Address - Phone:254-753-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)