Healthcare Provider Details

I. General information

NPI: 1003748138
Provider Name (Legal Business Name): SOPHIA GEORGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 FOXFIELD RD STE 202
SAINT CHARLES IL
60174-1402
US

IV. Provider business mailing address

6N690 GOODRICH AVE
SAINT CHARLES IL
60174-6516
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-3535
  • Fax:
Mailing address:
  • Phone: 224-201-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.023262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: