Angela Denise Wilburn, LCMHC NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A12117 Issued in NC

Practice address

515 Clanton Rd
Charlotte, NC 28217-1309

Phone

(704) 332-9001

NPI assigned

Jun 13, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: angela.wilburn.p1@direct.daymarkrecovery.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Mental Health

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NC

  Medicare reassignment NPD
• Wiley & Wilburn Counseling Services, PLLC

  • Professional Counselor
  • Charlotte, NC
  • NPI 1831855923
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1619326436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 CLANTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171309",
            "telephone_number": "043-329-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 CLANTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171309",
            "telephone_number": "704-332-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "ANGELA",
        "middle_name": "DENISE",
        "credential": "LCMHC NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A12117",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A12117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Wigley, LCAS
• Amanda Mary Wells Wigton, PT, DPT
• Phimrawee Wilaikruad, CMA, AAMA
• Lisa Bailey Wilbanks, FNP-C
• Rachael Wilbanks
• Jessica Dileo Wilchinski, OTR/L
• Jenelle Wilcox
• Mary M Wilcox
• Spencer Wilcox, PHARMD
• Tania Michelle Wilcox

• Professional Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.