Provider Demographics
NPI:1598237679
Name:GEORGE, NOLA
Entity Type:Individual
Prefix:MS
First Name:NOLA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOLA
Other - Middle Name:TITILAYO
Other - Last Name:GEORGE IUNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, RBT
Mailing Address - Street 1:316 S DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2737
Mailing Address - Country:US
Mailing Address - Phone:240-491-1376
Mailing Address - Fax:
Practice Address - Street 1:7375 EXECUTIVE PL STE 203
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6236
Practice Address - Country:US
Practice Address - Phone:301-970-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MD103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist