Provider Demographics
NPI:1487830980
Name:HUME, GEORGE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGE
Middle Name:ANNE
Last Name:HUME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-1076
Mailing Address - Country:US
Mailing Address - Phone:217-586-4591
Mailing Address - Fax:
Practice Address - Street 1:14792 CATLIN TILTON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-5116
Practice Address - Country:US
Practice Address - Phone:217-443-6430
Practice Address - Fax:217-443-1558
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200595OtherMEDICARE B PROVIDER