Provider Demographics
NPI:1235448374
Name:QUEYROUZE, GEORGIA DAHMES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:DAHMES
Last Name:QUEYROUZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 AZALEA CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7029
Mailing Address - Country:US
Mailing Address - Phone:985-264-3598
Mailing Address - Fax:985-674-0317
Practice Address - Street 1:4060 AZALEA CT
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7029
Practice Address - Country:US
Practice Address - Phone:985-264-3598
Practice Address - Fax:985-674-0317
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical