Healthcare Provider Details

I. General information

NPI: 1669599072
Provider Name (Legal Business Name): DIANE MARIE WILDMAN MALPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BELMONT AVE
YOUNGSTOWN OH
44502-1037
US

IV. Provider business mailing address

18070 CINNAMON TRL
MANTUA OH
44255-9560
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-2991
  • Fax:
Mailing address:
  • Phone: 440-543-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC-0004924
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberC-0004924
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberC-0004924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: