Healthcare Provider Details

I. General information

NPI: 1184029480
Provider Name (Legal Business Name): WALTER GEORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3718
US

IV. Provider business mailing address

3200 E ST SE APT G1
WASHINGTON DC
20019-2205
US

V. Phone/Fax

Practice location:
  • Phone: 202-581-0490
  • Fax:
Mailing address:
  • Phone: 301-379-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: