Provider Demographics
NPI:1073808796
Name:GEORGE, TAMARA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3309
Mailing Address - Country:US
Mailing Address - Phone:618-457-6707
Mailing Address - Fax:618-529-4563
Practice Address - Street 1:604 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3309
Practice Address - Country:US
Practice Address - Phone:618-457-6707
Practice Address - Fax:618-529-4563
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)