Provider Demographics
NPI:1174396071
Name:WAGLER, DARLENE GRACE (LMHCA)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:GRACE
Last Name:WAGLER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23009 LAKEVIEW DR UNIT B102
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2381
Mailing Address - Country:US
Mailing Address - Phone:206-586-4708
Mailing Address - Fax:
Practice Address - Street 1:23009 LAKEVIEW DR UNIT B102
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2381
Practice Address - Country:US
Practice Address - Phone:206-586-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61429073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health