Individual
LAUREN NICOLE WILDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7445 MONTICELLO RD APT 231, COLUMBIA, SC 29203-1502
(706) 424-2027
Mailing address
7445 MONTICELLO RD APT 231, COLUMBIA, SC 29203-1502
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4782318740
—
SC
Enumeration date
01/25/2023
Last updated
01/25/2023
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