Charmagne Wilder, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

01574 Issued in MN

Practice address

6363 France Ave S Ste 200
Edina, MN 55435-2140

Phone

(952) 903-1392

NPI assigned

Aug 6, 2019

Last updated

Mar 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Charmagne Derichs Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairview Express Care

  dba M Health Fairview Recovery Clinic

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment Care Compare group NPD
• Affinity Psychological Services, P.C.

  • Mental Health Counselor
  • Edina, MN
  • NPI 1245610856
  Medicare reassignment NPD
• St. Cloud Hospital

  • General Acute Care Hospital
  • Saint Cloud, MN
  • NPI 1043269798
  Medicare reassignment NPD
• Fairview Express Care

  dba Urologic Physicians

  • Urology Physician
  • Edina, MN
  • NPI 1699165324
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• St. Cloud Hospital

  dba Extended Contract Inpt Psych Services

  • Psychiatric Hospital Unit
  • Saint Cloud, MN
  • NPI 1932419058
  NPD
• St. Cloud Hospital

  dba CentraCare Home Health

  • Home Health Agency
  • Waite Park, MN
  • NPI 1952350605
  NPD

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1942855077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7137 CHICAGO AVE APT 7",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554233363",
            "telephone_number": "320-282-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352140",
            "telephone_number": "952-903-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "CHARMAGNE",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-06",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "01574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARMAGNE",
            "last_name": "DERICHS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allison Leigh Wienke, OTR/L
• Kathy Wieser, HIS
• Laura M Wike, MD
• Sarah Elizabeth Wilcox, OTR/L
• Sara Elizabeth Wildenberg, M.D.
• Lily Wiley, MD
• Robert C Wilke, M.D.
• Caroline Brooks Wilkening
• Andrew J. Will, MD
• Ashley Paige Willette, CNP

• Mental Health Counselor in Edina, MN
• Providers in Edina, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.