Provider Demographics
NPI:1114549169
Name:XIONG, GEORGE LEE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LEE
Last Name:XIONG
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 COUNTRY CLUB DR APT C
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3462
Mailing Address - Country:US
Mailing Address - Phone:847-220-8482
Mailing Address - Fax:
Practice Address - Street 1:977 LAKEVIEW PKWY STE 180
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1429
Practice Address - Country:US
Practice Address - Phone:847-220-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional