Doctor Name: | ALLISON WILDMAN WILDMAN |
NPI Number: | 1245695568 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CADCII |
License Number: | 254 |
Business Practice Address: | 104 N Commerce St Hinesville, GA - 313132720 |
Business Phone Number: | 9128773600 |
Business Fax Number: | 9128770421 |
Mailing Address: | 104 N Commerce St, HINESVILLE |
State: | GA |
Postal Code: | 313132720 |
Phone Number: | 9128773600 |
Fax Number: | 9128770421 |
NPI Enumeration Date: | 12/31/2015 |
NPI Last Update Date: | 12/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 254 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |