Individual
JOHN C WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LAC
Contact information
Practice address
125 CRESTRIDGE ST, FORT COLLINS, CO 80525-3934
(970) 494-9761
Mailing address
125 CRESTRIDGE ST, FORT COLLINS, CO 80525-3934
(970) 494-9761
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACD.0000026
CO
Other
Enumeration date
09/15/2014
Last updated
09/15/2014
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