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Individual

MRS. WILDA DARLENE WITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
429 W TERRA LN, O FALLON, MO 63366-2514
(636) 373-3236
(636) 272-4998
Mailing address
429 W TERRA LN, O FALLON, MO 63366-2514
(636) 373-3236
(636) 272-4998

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2002017413
MO
101YM0800X
Mental Health Counselor
Primary
2002017413
MO
101YP2500X
Professional Counselor
2002017413
MO
106H00000X
Marriage & Family Therapist
2002017413
MO

Other

Enumeration date
02/15/2010
Last updated
02/15/2010
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