Thomas-Wagoner, Licia Maria

Thomas-Wagoner, Licia Maria is an individual health care provider with primary practice located at 9409 Hull Street Rd Suite D1, North Chesterfield VA 23236-1200. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Thomas-Wagoner, Licia Maria can be contacted via phone (804) 745-2225.

Contact Information

Primary practice address
9409 Hull Street Rd Suite D1 North Chesterfield VA 23236-1200
Phone: (804) 745-2225
Fax: (804) 745-2242
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 0904006772 Virginia

Profile Details

NPI number 1750553384
LBN Legal business name Thomas-Wagoner, Licia Maria
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2008
Last updated Nov 12th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1750553384 NPPES
Virginia MEDICAID 004945352

Popular Providers