Provider Demographics
NPI:1811554793
Name:WILBOURN, MAKENZIE (LCMHC, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:WILBOURN
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 PISGAH HWY
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9035
Mailing Address - Country:US
Mailing Address - Phone:828-793-0398
Mailing Address - Fax:
Practice Address - Street 1:166 BRANNER AVE STE B
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3244
Practice Address - Country:US
Practice Address - Phone:828-232-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25402101YA0400X
NC15142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)