Provider Demographics
NPI:1659448298
Name:WILBURN, DENISE D (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:D
Last Name:WILBURN
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1439
Mailing Address - Country:US
Mailing Address - Phone:815-290-9711
Mailing Address - Fax:815-476-9752
Practice Address - Street 1:120 VINE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1439
Practice Address - Country:US
Practice Address - Phone:815-290-9711
Practice Address - Fax:815-476-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004030101YM0800X
IL180004030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health