Provider Demographics
NPI:1639289440
Name:WILDEY, CONSTANCE ELAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ELAINE
Last Name:WILDEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MARKET ST STE 412
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1532
Mailing Address - Country:US
Mailing Address - Phone:409-765-6321
Mailing Address - Fax:409-762-9151
Practice Address - Street 1:2200 MARKET ST STE 412
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1532
Practice Address - Country:US
Practice Address - Phone:409-765-6321
Practice Address - Fax:409-762-9151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMSW 032481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX871291QOtherBLUE CROSS/BLUE SHIELD
TXSO2MMedicare ID - Type Unspecified