MEDICARE: WILD INDIGO COUNSELING COLLECTIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588528905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD INDIGO COUNSELING COLLECTIVE

Provider Business Mailing Address
First Line	:	5203 AMBERHILL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2211
Country	:	US
Telephone Number	:	828-200-6304
Fax Number	:	336-281-5461

Provider Business Practice Location Address
First Line	:	5203 AMBERHILL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2211
Country	:	US
Telephone Number	:	336-296-8188
Fax Number	:	336-281-5461

Authorized Official
Title or Position	:	CO-OWNER/ PSCYHOTHERAPIST
Name	:	JANE TASTET
Credential	:	MA, LCMHCA
Telephone Number	:	336-296-8188

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

Similar Medicare Providers

1457485476 — ESSENTIAL CONCEPTS INC.
Practice Location Address:

2211 W MEADOWVIEW RD
GREENSBORO, NC
27407-3409

Practice Phone: 336-688-6757
Practice Fax:

1336478676 — DR. WILLIAM KOROTITSCH
Practice Location Address:

2211 W MEADOWVIEW RD , SUITE 114
GREENSBORO, NC
27407-3409

Practice Phone: 336-855-4649
Practice Fax: 336-855-4645

1952630949 — SIMRUN HEALTH SERVICES, INC
Practice Location Address:

2211 WESTMEADOWVIEW RD , SUITE # 108
GREENSBORO, NC
27407-1908

Practice Phone: 336-908-1044
Practice Fax:

1770803272 — AGAPE PSYCHOLOGICAL
Practice Location Address:

2211 W MEADOWVIEW RD , SUITE 114
GREENSBORO, NC
27407-3409

Practice Phone: 336-855-4649
Practice Fax: 336-855-4645

1750696274 — LATOYA DAVIS LUCAS NP
Practice Location Address:

2211 W MEADOWVIEW RD STE 107
GREENSBORO, NC
27407-3408

Practice Phone: 336-543-0480
Practice Fax: 336-313-2417

1558663070 — SERENITY COUNSELING & RESOURCE CENTER
Practice Location Address:

2211 W MEADOWVIEW RD STE 10
GREENSBORO, NC
27407-3400

Practice Phone: 336-617-8910
Practice Fax:

Directions to “WILD INDIGO COUNSELING COLLECTIVE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.