Provider Demographics
NPI:1326260852
Name:WILDER, DIRHONDA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:DIRHONDA
Middle Name:KAY
Last Name:WILDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E CHEROKEE ST
Mailing Address - Street 2:A
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4722
Mailing Address - Country:US
Mailing Address - Phone:918-310-5936
Mailing Address - Fax:918-917-8006
Practice Address - Street 1:1102 E CHEROKEE ST
Practice Address - Street 2:A
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4722
Practice Address - Country:US
Practice Address - Phone:918-310-5936
Practice Address - Fax:918-917-8006
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional