Provider Demographics
NPI:1902001720
Name:WAGLEY, JAMES M (LCSW-BACS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:WAGLEY
Suffix:
Gender:M
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 NATCHITOCHES HWY
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-7342
Mailing Address - Country:US
Mailing Address - Phone:318-602-9206
Mailing Address - Fax:
Practice Address - Street 1:2203 NATCHITOCHES HWY
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-7342
Practice Address - Country:US
Practice Address - Phone:318-602-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical