Healthcare Provider Details

I. General information

NPI: 1639720337
Provider Name (Legal Business Name): BRITTNEY SHANESSE GEORGE LPC-S, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 ALLECINGIE PKWY
NORTH CHESTERFIELD VA
23235-4301
US

IV. Provider business mailing address

11505 ALLECINGIE PKWY
NORTH CHESTERFIELD VA
23235-4301
US

V. Phone/Fax

Practice location:
  • Phone: 864-613-6677
  • Fax: 434-404-4621
Mailing address:
  • Phone: 864-613-6677
  • Fax: 434-404-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008654
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: