Individual
ROGER TODD DEWILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED. LPC-MHSP(TEMP)
Contact information
Practice address
332 SUMNER HALL DR, GALLATIN, TN 37066-3129
(615) 460-4500
Mailing address
332 SUMNER HALL DR, GALLATIN, TN 37066-3129
(615) 460-4500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3695
TN
Other
Enumeration date
08/19/2017
Last updated
08/19/2017
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