Provider Demographics
NPI:1265168074
Name:WILBURN, STINA R (COMT)
Entity type:Individual
Prefix:
First Name:STINA
Middle Name:R
Last Name:WILBURN
Suffix:
Gender:F
Credentials:COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24315-5480
Mailing Address - Country:US
Mailing Address - Phone:276-688-3667
Mailing Address - Fax:
Practice Address - Street 1:537 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-5480
Practice Address - Country:US
Practice Address - Phone:276-688-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist