Provider Demographics
NPI:1902071798
Name:WISNER, CRAIG EDWARD (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:EDWARD
Last Name:WISNER
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 1:409 CAMDEN AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5408
Mailing Address - Country:US
Mailing Address - Phone:443-944-8822
Mailing Address - Fax:410-219-2666
Practice Address - Street 1:409 CAMDEN AVE APT A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5408
Practice Address - Country:US
Practice Address - Phone:443-944-8822
Practice Address - Fax:410-219-2666
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0646101YA0400X
MD214691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520202702Medicaid
MD609550004Medicaid