Provider Demographics
NPI:1992596654
Name:WILDFLOWER THERAPY PLLC
Entity type:Organization
Organization Name:WILDFLOWER THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-785-4957
Mailing Address - Street 1:3441 SOUTH BLVD UNIT 455
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2074
Mailing Address - Country:US
Mailing Address - Phone:843-602-7950
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 323
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0089
Practice Address - Country:US
Practice Address - Phone:980-785-4957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty