Provider Demographics
NPI:1023155256
Name:WILDAY, FRIEDERIKE (LPC)
Entity type:Individual
Prefix:
First Name:FRIEDERIKE
Middle Name:
Last Name:WILDAY
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 1:850C WADE HAMPTON BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4942
Mailing Address - Country:US
Mailing Address - Phone:864-238-0590
Mailing Address - Fax:864-252-9300
Practice Address - Street 1:850C WADE HAMPTON BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4942
Practice Address - Country:US
Practice Address - Phone:864-238-0590
Practice Address - Fax:864-252-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1330Medicaid