Healthcare Provider Details

I. General information

NPI: 1174957567
Provider Name (Legal Business Name): GEORGE ELMER WILBUR LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

1004 WILSON POINT RD APT H
MIDDLE RIVER MD
21220-5026
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax:
Mailing address:
  • Phone: 443-739-1472
  • Fax: 443-759-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number08959
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: