Leslie Brodie Wilder, LCMHCS, LCAS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S10318 Issued in NC

Practice address

4804 Wedgefield Dr
Wilmington, NC 28409-3981

Phone

(910) 619-0760

NPI assigned

Jun 20, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1194164459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4804 WEDGEFIELD DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284093981",
            "telephone_number": "910-619-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 WEDGEFIELD DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284093981",
            "telephone_number": "910-619-0760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Greenfield St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284016456",
            "country_code": "US",
            "telephone_number": "910-798-3500",
            "fax_number": "910-798-7834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDER",
        "first_name": "LESLIE",
        "middle_name": "BRODIE",
        "credential": "LCMHCS, LCAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-20",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3294",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "10318",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "S10318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.