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General NPI Number Information
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NPI Number | 1023315710
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Entity Type | Individual
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Provider Name | VICKY LYNNE WILDER NCC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 8913 BLVD OF THE GENERAL
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553
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Country | US
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Telephone | 540-786-7227
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Fax | 877-771-3419
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Provider Business Mailing Address
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Address Line | 8913 BOULVARD OF THE GENERAL
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553
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Country | US
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Telephone | 540-786-7227
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Fax | 877-771-3419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61066
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 466-1986
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License Number State | VA
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