Doctor Name: | DIRHONDA KAY WILDER |
NPI Number: | 1326260852 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BSW, MHR |
License Number: | |
Business Practice Address: | 405 E Excelsior Ave Vinita, OK - 743014226 |
Business Phone Number: | 9182566476 |
Business Fax Number: | 9182563628 |
Mailing Address: | 405 E Excelsior Ave, VINITA |
State: | OK |
Postal Code: | 743014226 |
Phone Number: | 9182566476 |
Fax Number: | 9182563628 |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 08/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |