Provider Demographics
NPI:1295880177
Name:WAGNER, LOUISE WHELCHEL (RN,MSN,CS-P)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:WHELCHEL
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RN,MSN,CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOILAND DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3228
Mailing Address - Country:US
Mailing Address - Phone:302-764-3731
Mailing Address - Fax:410-398-3325
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5769
Practice Address - Country:US
Practice Address - Phone:410-398-9557
Practice Address - Fax:410-398-3325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist