Provider Demographics
NPI:1528493319
Name:WUILLERMIN, COLBY (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:COLBY
Middle Name:
Last Name:WUILLERMIN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-2025
Mailing Address - Country:US
Mailing Address - Phone:609-457-6489
Mailing Address - Fax:
Practice Address - Street 1:1401 ATLANTIC AVE STE 2100
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7001
Practice Address - Country:US
Practice Address - Phone:609-457-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00170800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health