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Individual
DR. VANESSA LASHALLE WILDER
Active
Individual
DR. VANESSA LASHALLE WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
640101048
MI
101YP2500X
Professional Counselor
6401011048
MI
Other
Enumeration date
12/14/2014
Last updated
03/03/2022
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