Provider Demographics
NPI:1245367192
Name:WILDER, DEBORAH SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SHARON
Last Name:WILDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1181
Mailing Address - Country:US
Mailing Address - Phone:404-237-8962
Mailing Address - Fax:404-636-6434
Practice Address - Street 1:3384 PEACHTREE RD NE
Practice Address - Street 2:SUITE 610
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1181
Practice Address - Country:US
Practice Address - Phone:404-237-8962
Practice Address - Fax:404-636-6434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health