Healthcare Provider Details

I. General information

NPI: 1952859118
Provider Name (Legal Business Name): ANN HARRISON WILDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E WILLIAM DAVID PKWY
METAIRIE LA
70005-3308
US

IV. Provider business mailing address

210 E WILLIAM DAVID PKWY
METAIRIE LA
70005-3308
US

V. Phone/Fax

Practice location:
  • Phone: 504-481-0157
  • Fax:
Mailing address:
  • Phone: 504-481-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2521
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: