Provider Demographics
NPI:1902649569
Name:WILDER, DAVID PARKER (LCMHC, LCAS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PARKER
Last Name:WILDER
Suffix:
Gender:M
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RAVENSCROFT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3683
Mailing Address - Country:US
Mailing Address - Phone:828-827-7239
Mailing Address - Fax:
Practice Address - Street 1:5 RAVENSCROFT DR STE 102
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3683
Practice Address - Country:US
Practice Address - Phone:828-827-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28324101YA0400X
NC18150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)