Individual
ATHENA MARIE WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5870 ARLINGTON AVE, RIVERSIDE, CA 92504-2037
(951) 683-6596
Mailing address
22569 CLIMBING ROSE DR, MORENO VALLEY, CA 92557-6033
(951) 254-0696
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
13019
CA
101YP2500X
Professional Counselor
Primary
19703
CA
Other
Enumeration date
12/16/2021
Last updated
10/14/2025
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