Provider Demographics
NPI:1598990442
Name:DEGEORGE, COLLEEN LEHN (LISW-CP/LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LEHN
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:LISW-CP/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 RUTLEDGE AVENUE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403
Mailing Address - Country:US
Mailing Address - Phone:908-461-7014
Mailing Address - Fax:732-923-5277
Practice Address - Street 1:198 RUTLEDGE AVENUE
Practice Address - Street 2:SUITE 8
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:908-461-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053440001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical