Provider Demographics
NPI:1881899078
Name:COOKE WILDER, TONI LEE (CATC)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:LEE
Last Name:COOKE WILDER
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:LEE
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 WOLLAM AVE
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4364
Mailing Address - Country:US
Mailing Address - Phone:925-458-1978
Mailing Address - Fax:925-458-8996
Practice Address - Street 1:510 WOLLAM AVE
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-4364
Practice Address - Country:US
Practice Address - Phone:925-458-1978
Practice Address - Fax:925-458-8996
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW0503011409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)