Provider Demographics
NPI:1548747330
Name:WILBURN, SAMEKA
Entity Type:Individual
Prefix:
First Name:SAMEKA
Middle Name:
Last Name:WILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 ARGYLE FOREST BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6127
Mailing Address - Country:US
Mailing Address - Phone:904-236-1268
Mailing Address - Fax:
Practice Address - Street 1:8410 CHESWICK OAK AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7352
Practice Address - Country:US
Practice Address - Phone:904-236-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical