Individual provider · Type 1 NPI
Gerald Wagner Jr., LADC
Addiction (Substance Use Disorder) Counselor · New London, CT
NPI number
1962759084
Active
Practice location
21 Montauk Ave
New London, CT 06320-4906
Fax (860) 271-4797
Mailing address
PO Box 390
New London, CT 06320-0390
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 000326 (CT) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1962759084
Gerald Wagner Jr., LADC's National Provider Identifier is 1962759084, issued on Aug 8, 2012. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in New London, CT. The record was last updated on Dec 21, 2016.