Active NPI
William Wagner
- Mental Health Counselor
- Largo, MD
National Provider Identifier
1386986677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LC4481
- Practice address
- 9701 Apollo Dr
Suite 441
Largo, MD 20774-4783 - Phone
- (410) 318-9215
- Fax
- (240) 764-6741
- NPI assigned
- Mar 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LC4481 | MD | Primary |
| Professional Counselor | 101YP2500X | LC4481 | MD |
Addresses
Primary practice location
9701 Apollo Dr
Suite 441
Largo, MD 20774-4783
Mailing address
9701 Apollo Dr
Suite 441
Largo, MD 20774-4783
Phone (410) 318-9215
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LC4481 | Other | MD | MD LICENSE LC4481 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC4481 | MD | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tracy Stubblefield LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Largo, MD
- NPI 1346557402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364169600000",
"number": "1386986677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9701 APOLLO DR",
"address_2": "SUITE 441",
"city": "LARGO",
"state": "MD",
"postal_code": "207744783",
"telephone_number": "410-318-9215",
"fax_number": "240-764-6741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9701 APOLLO DR",
"address_2": "SUITE 441",
"city": "LARGO",
"state": "MD",
"postal_code": "207744783",
"telephone_number": "410-318-9215",
"fax_number": "240-764-6741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "WILLIAM",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-25",
"last_updated": "2013-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LC4481",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC4481",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD LICENSE LC4481",
"identifier": "LC4481",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Largo, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.