Individual
CJ WILD EVERHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
139 NONOTUCK ST, FLORENCE, MA 01062-1907
(617) 417-1055
Mailing address
PO BOX 60071, FLORENCE, MA 01062-0071
(617) 417-1055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
007547
NY
101YM0800X
Mental Health Counselor
Primary
12340-MH-CC
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235928029
NPI
MA
Enumeration date
01/31/2018
Last updated
07/02/2025
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