Provider Demographics
NPI:1841427184
Name:WAGGONER, DONITA RENEE (M ED LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONITA
Middle Name:RENEE
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1625 W OWEN K GARRIOTT RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5653
Mailing Address - Country:US
Mailing Address - Phone:580-747-8574
Mailing Address - Fax:580-233-6932
Practice Address - Street 1:1625 W OWEN K GARRIOTT RD
Practice Address - Street 2:SUITE F
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-747-8574
Practice Address - Fax:580-233-6932
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health