Provider Demographics
NPI:1235524901
Name:WILBUR, MICHELE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WILBUR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4210
Mailing Address - Country:US
Mailing Address - Phone:410-610-7530
Mailing Address - Fax:
Practice Address - Street 1:995 PRINCE FREDERICK BLVD STE 209
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-5101
Practice Address - Country:US
Practice Address - Phone:410-610-7530
Practice Address - Fax:410-414-9413
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11599101YP2500X
MDLGP6156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional