Healthcare Provider Details

I. General information

NPI: 1558735662
Provider Name (Legal Business Name): CHRISTINA WILEY MED LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 CALIFORNIA LN
OAK RIDGE LA
71264-9331
US

IV. Provider business mailing address

1117 MARION HWY
FARMERVILLE LA
71241-9313
US

V. Phone/Fax

Practice location:
  • Phone: 318-732-8023
  • Fax: 318-605-4133
Mailing address:
  • Phone: 318-503-8682
  • Fax: 318-982-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4851
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: