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Individual
MR. TIMOTHY M WILDER
Active
Individual
MR. TIMOTHY M WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002845
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199752
MANAGED HEALTH NETWORK
VA
01
—
2041553
CIGNA
VA
01
—
253575
ANTHEM BCBS
VA
01
—
272041
MAMSI
VA
01
—
465418
VALUE OPTIONS
VA
01
—
7335124
AETNA
VA
Enumeration date
12/06/2005
Last updated
07/13/2026
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