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General NPI Number Information
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NPI Number | 1831855923
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Entity Type | Organization
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Legal Business Name | WILEY & WILBURN COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 6120 TIARA LN APT 101
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City | CHARLOTTE
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State | NC
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Zip | 28212-8460
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Country | US
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Telephone | 858-829-9272
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 214
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City | CONCORD
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State | NC
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Zip | 28027
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Country | US
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Telephone | 704-663-5179
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | ANGELA DENISE WILBURN
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Credential | LCMHC NCC
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Telephone | 704-663-5179
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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 |
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License Number State |
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