Provider Demographics
NPI:1821317306
Name:WAGNER, WILLIAM BENJAMIN (CADC-II-CA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:WAGNER
Suffix:
Gender:M
Credentials:CADC-II-CA
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1643 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2316
Mailing Address - Country:US
Mailing Address - Phone:925-324-3741
Mailing Address - Fax:925-439-7127
Practice Address - Street 1:1350 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4190
Practice Address - Country:US
Practice Address - Phone:925-313-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
CAAII052430218172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health