Individual
MRS. JULIE ANNE DE WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPCC
Contact information
Practice address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Mailing address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC01711
MN
Other
Enumeration date
08/03/2016
Last updated
01/19/2018
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