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General NPI Number Information
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NPI Number | 1124312913
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Entity Type | Individual
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Provider Name | SANDRA WILSON WILBOURNE MS, LPCA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 20 COURT ST
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City | ROXBORO
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State | NC
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Zip | 27573-5202
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Country | US
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Telephone | 919-339-1585
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Fax | 434-374-5396
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Provider Business Mailing Address
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Address Line | 2182 WILBOURNE RD
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City | SKIPWITH
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State | VA
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Zip | 23968-2218
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Country | US
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Telephone | 434-374-5396
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Fax | 434-374-5396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A8842
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License Number State | NC
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