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Individual
LESLIE BRODIE WILDER
Active
Individual
LESLIE BRODIE WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCS, LCAS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3294
NC
101YM0800X
Mental Health Counselor
Primary
S10318
NC
101YP2500X
Professional Counselor
10318
NC
Other
Enumeration date
06/20/2013
Last updated
09/28/2023
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