Provider Demographics
NPI:1033478649
Name:GEORGE, ISABELLE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:DOMINIQUE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 AMAYA DR
Mailing Address - Street 2:#204
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4156
Mailing Address - Country:US
Mailing Address - Phone:619-784-3884
Mailing Address - Fax:
Practice Address - Street 1:5811 AMAYA DR
Practice Address - Street 2:#204
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4156
Practice Address - Country:US
Practice Address - Phone:619-784-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAIMF95477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator