Individual
NICOLE WILDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14229 TORREY RD # 3, FENTON, MI 48430-3308
(810) 214-2624
Mailing address
2421 GOLDEN SHORE DR, FENTON, MI 48430-1058
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
TPMC5026
FL
101YP2500X
Professional Counselor
Primary
6401222623
MI
Other
Enumeration date
03/15/2022
Last updated
04/09/2026
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