Provider Demographics
NPI:1922778109
Name:WAGNER, BILLIE JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE JO
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 GOLFSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6353
Mailing Address - Country:US
Mailing Address - Phone:863-381-1578
Mailing Address - Fax:
Practice Address - Street 1:1570 LAKEVIEW DR STE 2B
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7959
Practice Address - Country:US
Practice Address - Phone:863-633-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW189631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical