Provider Demographics
NPI:1326619016
Name:GEORGES, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GEORGES
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 1:31 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-3614
Mailing Address - Country:US
Mailing Address - Phone:802-922-7513
Mailing Address - Fax:
Practice Address - Street 1:31 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NH
Practice Address - Zip Code:03216-3614
Practice Address - Country:US
Practice Address - Phone:802-922-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH96613101YS0200X
NH1121041S0200X
NH0141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool