Healthcare Provider Details

I. General information

NPI: 1356657571
Provider Name (Legal Business Name): BILLIE NICOLE WILDER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BELINDA BLVD
DANVILLE KY
40422-3217
US

IV. Provider business mailing address

106 BELINDA BLVD
DANVILLE KY
40422-3217
US

V. Phone/Fax

Practice location:
  • Phone: 866-755-4258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number174900
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number174900
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: