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General NPI Number Information
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NPI Number | 1588528905
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Entity Type | Organization
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Legal Business Name | WILD INDIGO COUNSELING COLLECTIVE
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 5203 AMBERHILL DR
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City | GREENSBORO
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State | NC
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Zip | 27455-2211
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Country | US
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Telephone | 336-296-8188
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Fax | 336-281-5461
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Provider Business Mailing Address
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Address Line | 5203 AMBERHILL DR
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City | GREENSBORO
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State | NC
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Zip | 27455-2211
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Country | US
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Telephone | 828-200-6304
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Fax | 336-281-5461
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Authorized Official
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Title or Position | CO-OWNER/ PSCYHOTHERAPIST
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Name | JANE TASTET
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Credential | MA, LCMHCA
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Telephone | 336-296-8188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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