Provider Demographics
NPI:1518569284
Name:GEORGE, MARY (MA,LCADC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MA,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 POLAND ST
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2328
Mailing Address - Country:US
Mailing Address - Phone:609-847-8838
Mailing Address - Fax:
Practice Address - Street 1:48 POLAND ST
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2328
Practice Address - Country:US
Practice Address - Phone:609-847-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00313300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)