Provider Demographics
NPI:1467692202
Name:GEORGE, VICKIE L
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2250 SATELLITE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4906
Mailing Address - Country:US
Mailing Address - Phone:770-813-8181
Mailing Address - Fax:770-813-1545
Practice Address - Street 1:2250 SATELLITE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4906
Practice Address - Country:US
Practice Address - Phone:770-813-8181
Practice Address - Fax:770-813-1545
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000307101YP2500X
GA000727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional