Provider Demographics
NPI:1376161224
Name:WAGAR, LAURA BETH (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:WAGAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 SUBLIME TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7280
Mailing Address - Country:US
Mailing Address - Phone:404-626-5500
Mailing Address - Fax:
Practice Address - Street 1:203 OAKSIDE LN STE F
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6407
Practice Address - Country:US
Practice Address - Phone:678-213-2194
Practice Address - Fax:404-806-1832
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009134101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor