Michael Robert Wildman, LCAS, CCS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

430 Battleground Ave Unit a
Greensboro, NC 27401-2104

Phone

(336) 575-9951

NPI assigned

Aug 27, 2019

Last updated

Aug 27, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1255989810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PAMLICO DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274088511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 BATTLEGROUND AVE UNIT A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012104",
            "telephone_number": "336-575-9951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "credential": "LCAS, CCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wild Indigo Counseling Collective
• Colt Wyatt Wilde, DC
• Alexandra Titus Wilder, APRN-BC
• Brandy Wilder, ITFS
• Carol A Wilder
• Angela Wiley, LPC, LCAS, MAC
• Jessica Wiley, RPH
• Marshall Thomas Wilfong
• Darian Wilhelm
• Arionna Wilkerson, MS, LCMHCA

• Addiction (Substance Use Disorder) Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.