Provider Demographics
NPI:1164678496
Name:GEORGE, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
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 1:18 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4609
Mailing Address - Country:US
Mailing Address - Phone:831-722-5914
Mailing Address - Fax:831-722-8311
Practice Address - Street 1:18 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4609
Practice Address - Country:US
Practice Address - Phone:831-722-5914
Practice Address - Fax:831-722-8311
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN6698949OtherLICENCE