MEDICARE: DAWN WILBURN MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401013122	MI

General Provider Information

NPI Number	:	1477944536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN WILBURN MA, LPC, NCC

Provider Business Mailing Address
First Line	:	800 E ELLIS RD # 567
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-288-6591
Fax Number	:	231-375-8138

Provider Business Practice Location Address
First Line	:	800 E ELLIS RD # 567
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-638-6367
Fax Number	:	231-375-8138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	08/14/2024

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