Provider Demographics
NPI:1437368933
Name:WILDER, WILLIAM FRANK III (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FRANK
Last Name:WILDER
Suffix:III
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-0184
Mailing Address - Country:US
Mailing Address - Phone:704-871-1712
Mailing Address - Fax:704-871-9354
Practice Address - Street 1:146 E MCLELLAND AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2611
Practice Address - Country:US
Practice Address - Phone:704-871-1712
Practice Address - Fax:704-871-9354
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional