Provider Demographics
NPI:1780714360
Name:WILBUR, SANDRA S (LCSW BCD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:S
Last Name:WILBUR
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10229 ASPEN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032
Mailing Address - Country:US
Mailing Address - Phone:703-323-7538
Mailing Address - Fax:703-323-7538
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 510
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-591-8092
Practice Address - Fax:703-323-7538
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA043932OtherBCBS ANTHEM
VA2697970C2OtherMAMSI OPTIMUM CHOICE