Provider Demographics
NPI:1326462680
Name:WILBURN, HOLLY (MS,NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:WILBURN
Suffix:
Gender:F
Credentials:MS,NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8667
Mailing Address - Country:US
Mailing Address - Phone:724-813-1619
Mailing Address - Fax:
Practice Address - Street 1:100 BIRCH CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-8667
Practice Address - Country:US
Practice Address - Phone:724-813-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCA10910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health