Provider Demographics
NPI:1114352960
Name:WILD, MARGARET NELL (PHD, MS, MFTI)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:NELL
Last Name:WILD
Suffix:
Gender:F
Credentials:PHD, MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4539
Mailing Address - Country:US
Mailing Address - Phone:951-367-4446
Mailing Address - Fax:
Practice Address - Street 1:FOOTPRINTS COUNSELING SERVICES
Practice Address - Street 2:34455 YUCAIPA BLVD
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:951-367-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT91521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist