Provider Demographics
NPI:1174957567
Name:WILBUR, GEORGE ELMER (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ELMER
Last Name:WILBUR
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 WILSON POINT RD APT H
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-5026
Mailing Address - Country:US
Mailing Address - Phone:443-739-1472
Mailing Address - Fax:443-759-8209
Practice Address - Street 1:10 DISTILLERY RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5344
Practice Address - Country:US
Practice Address - Phone:410-871-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD08959OtherSTATE OF MARYLAND SOCIAL WORK LICENSE NUMBER: