| Doctor Name: | MARJORIE WILDE |
| NPI Number: | 1124186382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LMHC |
| License Number: | MH 2558 |
| Business Practice Address: | 1000 Executive Dr Suite 9 Oviedo, FL - 327658140 |
| Business Phone Number: | 4079710266 |
| Business Fax Number: | |
| Mailing Address: | 677 Silver Birch Pl, LONGWOOD |
| State: | FL |
| Postal Code: | 327508424 |
| Phone Number: | 4073245110 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH 2558 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |