Provider Demographics
NPI:1326507203
Name:PIPKIN, GEORGE E III (LPC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:PIPKIN
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LEGION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-5506
Mailing Address - Country:US
Mailing Address - Phone:203-562-2264
Mailing Address - Fax:203-789-1335
Practice Address - Street 1:109 LEGION AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-5506
Practice Address - Country:US
Practice Address - Phone:203-562-2264
Practice Address - Fax:203-789-1335
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty