Wildman, Diane Marie

Wildman, Diane Marie is an sole proprietor health care provider with primary practice located at 611 Belmont Ave , Youngstown OH 44502-1037. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / School, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wildman, Diane Marie can be contacted via phone (330) 744-2991.

Contact Information

Primary practice address
611 Belmont Ave Youngstown OH 44502-1037
Phone: (330) 744-2991
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X C-0004924 Ohio
Behavioral Health & Social Service Providers / School 101YS0200X C-0004924 Ohio
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X C-0004924 Ohio

Profile Details

NPI number 1669599072
LBN Legal business name Wildman, Diane Marie
Credentials MALPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 23rd, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669599072 NPPES
Ohio Other 000000126040 ANTHEM BCBS
Ohio Other 2164381 ANTHEM BCBS

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