| Doctor Name: | KIMBERLY WILDER |
| NPI Number: | 1164835849 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 3069-A |
| Business Practice Address: | 2305 Vineyard Dr # Drive6 Winterville, NC - 285908299 |
| Business Phone Number: | 2523279415 |
| Business Fax Number: | |
| Mailing Address: | 2305 Vineyard Dr # Drive6, WINTERVILLE |
| State: | NC |
| Postal Code: | 285908299 |
| Phone Number: | 2523279415 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 3069-A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |