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General NPI Number Information
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NPI Number | 1063216414
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Entity Type | Organization
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Legal Business Name | WILDER WELLNESS CENTER
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 807 WILLIAMSON RD STE 202
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City | MOORESVILLE
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State | NC
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Zip | 28117-8560
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Country | US
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Telephone | 704-912-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 807 WILLIAMSON RD STE 202
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City | MOORESVILLE
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State | NC
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Zip | 28117-8560
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Country | US
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Telephone | 704-912-4236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM FRANK WILDER III
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Credential | LCMHC
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Telephone | 704-456-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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