Provider Demographics
NPI:1275684888
Name:BRINES, GEORGE P (NCACII, ICACII)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:BRINES
Suffix:
Gender:M
Credentials:NCACII, ICACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 STANFORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905
Mailing Address - Country:US
Mailing Address - Phone:765-449-9115
Mailing Address - Fax:765-446-4224
Practice Address - Street 1:3768 ROME DRIVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-449-9115
Practice Address - Fax:765-446-4224
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)