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General NPI Number Information
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NPI Number | 1811554793
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Entity Type | Individual
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Provider Name | MAKENZIE WILBOURN LCMHC, LCAS, CSI
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Gender | Female
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Dates
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Enumeration Date | 05/25/2019
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 166 BRANNER AVE STE B
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City | WAYNESVILLE
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State | NC
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Zip | 28786-3244
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Country | US
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Telephone | 828-232-8934
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 PISGAH HWY
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City | CANDLER
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State | NC
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Zip | 28715-9035
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Country | US
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Telephone | 828-793-0398
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 25402
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15142
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License Number State | NC
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