Provider Demographics
NPI:1659547396
Name:THORNE, WILBUR DONOVAN (LICSW, LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:WILBUR
Middle Name:DONOVAN
Last Name:THORNE
Suffix:
Gender:M
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 N BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2666
Mailing Address - Country:US
Mailing Address - Phone:301-767-7500
Mailing Address - Fax:
Practice Address - Street 1:8315 N BROOK LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2666
Practice Address - Country:US
Practice Address - Phone:301-767-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500789751041C0700X
MD169341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLG50077743Medicaid