Provider Information for 1467044859
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THOMAS HENRY WILDER LPC
Sex: Male
NPI: 1467044859
Last Updated: 2021-02-07
Certification Date: 2021-02-07
Certification Date: 2021-02-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1467044859 | ||||||||
| Enumeration Date | 2021-02-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 110 JACKSON ST WETUMPKA, AL 36092-3020 United States Phone: 469-240-1580 | Fax: | ||||||||
| Primary Practice Address | 110 JACKSON ST WETUMPKA, AL 36092-3020 United States Phone: 469-240-1580 | Fax: | ||||||||
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