Individual
DIANA WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
823 CARROLL ST, SUITE B, MANDEVILLE, LA 70448-5126
(985) 674-0488
(985) 674-0336
Mailing address
823 CARROLL ST, SUITE B, MANDEVILLE, LA 70448-5126
(985) 674-0488
(985) 674-0336
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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