Individual
CARRIE WILDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2392 EDGEWOOD AVE N, JACKSONVILLE, FL 32254-1725
(904) 781-7797
Mailing address
2807 GIBSON POST RD, FOLKSTON, GA 31537-7127
(912) 276-0622
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
FL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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