| NPI | 1992578363 |
|---|---|
| Doing Business As | WYLD TRANSFORMATION |
| Entity Type | Organization |
| Authorized Contact | HOLLY SKINNER Credentialing 501-454-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-08-19 |