Provider Demographics
NPI:1679307508
Name:WILDFLOWER THERAPY GROUP
Entity type:Organization
Organization Name:WILDFLOWER THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER, LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPPAH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-524-3390
Mailing Address - Street 1:515 BENDEMEER LN
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9751
Mailing Address - Country:US
Mailing Address - Phone:919-524-3390
Mailing Address - Fax:
Practice Address - Street 1:1301 MOUNTAIN MILL DR APT 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6457
Practice Address - Country:US
Practice Address - Phone:919-524-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACLYN SAPPAH THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty