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General NPI Number Information
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NPI Number | 1053786863
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Entity Type | Organization
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Legal Business Name | GEORG ASSOCIATES
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 1518 WALNUT ST SUITE 607
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3419
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Country | US
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Telephone | 484-324-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 440 W SEDGWICK ST SUITE A106
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3045
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Country | US
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Telephone | 484-324-8370
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LOLA GEORG
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Credential | LPC
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Telephone | 484-324-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC004689
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License Number State | PA
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