Provider Demographics
NPI:1073165445
Name:GEORGE, VICTORIA A
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
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 1:506 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3004
Mailing Address - Country:US
Mailing Address - Phone:318-598-5040
Mailing Address - Fax:
Practice Address - Street 1:2807 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3749
Practice Address - Country:US
Practice Address - Phone:318-654-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator