Provider Demographics
NPI:1952859118
Name:WILDER, ANN HARRISON (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:HARRISON
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 1:428 FINCHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4631
Mailing Address - Country:US
Mailing Address - Phone:504-481-0157
Mailing Address - Fax:
Practice Address - Street 1:428 FINCHLEY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4631
Practice Address - Country:US
Practice Address - Phone:504-481-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional