Provider Demographics
NPI:1477944536
Name:WILBURN, DAWN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WILBURN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 GRAND HAVEN RD STE 106A
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5546
Mailing Address - Country:US
Mailing Address - Phone:231-288-6591
Mailing Address - Fax:231-354-3517
Practice Address - Street 1:427 SEMINOLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3747
Practice Address - Country:US
Practice Address - Phone:231-638-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013122101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor