Provider Demographics
NPI:1801402490
Name:WILDING, SHAWN DAVID SR (MS, NBCC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DAVID
Last Name:WILDING
Suffix:SR
Gender:M
Credentials:MS, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WIELAND DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-3100
Mailing Address - Country:US
Mailing Address - Phone:706-577-1330
Mailing Address - Fax:
Practice Address - Street 1:105 WIELAND DR
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-3100
Practice Address - Country:US
Practice Address - Phone:706-577-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health