Provider Demographics
NPI:1154135630
Name:WAGNER, ADRIANNE BROOKE (MA, NCC)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:BROOKE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-7018
Mailing Address - Country:US
Mailing Address - Phone:970-210-3237
Mailing Address - Fax:
Practice Address - Street 1:759 HORIZON DR STE E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8737
Practice Address - Country:US
Practice Address - Phone:970-210-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health