Provider Demographics
NPI:1306018841
Name:GEORGE, BERNADETTE (MA, LLPC)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23727 W CHICAGO
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1338
Mailing Address - Country:US
Mailing Address - Phone:313-533-7708
Mailing Address - Fax:313-533-7708
Practice Address - Street 1:29150 CARLYSLE ST
Practice Address - Street 2:SUITE 135, BOX 3
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2868
Practice Address - Country:US
Practice Address - Phone:734-721-6008
Practice Address - Fax:734-467-5719
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health