Provider Demographics
NPI:1558982538
Name:WILBURN-LUNSFORD, DENISE LAUREN (LSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LAUREN
Last Name:WILBURN-LUNSFORD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 AUBURN AVE STE 428
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-0635
Mailing Address - Fax:513-585-0775
Practice Address - Street 1:2123 AUBURN AVE STE 428
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-0635
Practice Address - Fax:513-585-0775
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1700635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker