Individual
DANIELLE WILDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
605 NEWNAN ST, CARROLLTON, GA 30117-3428
(678) 796-8255
Mailing address
605 NEWNAN ST, CARROLLTON, GA 30117-3428
(678) 796-8255
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001451
GA
Other
Enumeration date
03/13/2016
Last updated
10/14/2016
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