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1124312913 NPI number — SANDRA WILSON WILBOURNE MS, LPCA

NPI Number: 1124312913
Health Care Provider/Practitioner: SANDRA WILSON WILBOURNE MS, LPCA

Information about “1124312913” NPI (SANDRA WILSON WILBOURNE MS, LPCA) exists in 1124312913 in HTML format HTML  |  1124312913 in plain Text format TXT  |  1124312913 in PDF (Portable Document Format) PDF  |  1124312913 in an XML format XML  formats.

NPI Number : 1124312913 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124312913",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILBOURNE",
    "FirstName": "SANDRA",
    "MiddleName": "WILSON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, LPCA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2182 WILBOURNE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SKIPWITH",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23968-2218",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "434-374-5396",
    "MailingAddressFaxNumber": "434-374-5396",
    "FirstLinePracticeLocationAddress": "20 COURT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROXBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27573-5202",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-339-1585",
    "PracticeLocationAddressFaxNumber": "434-374-5396",
    "EnumerationDate": "06/08/2011",
    "LastUpdateDate": "07/18/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "A8842",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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