Provider Demographics
NPI:1609019835
Name:KNIPP, GEORGE HERBERT (BS, LCPC, LCADC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HERBERT
Last Name:KNIPP
Suffix:
Gender:M
Credentials:BS, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5302
Mailing Address - Country:US
Mailing Address - Phone:410-788-3360
Mailing Address - Fax:
Practice Address - Street 1:800 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1722
Practice Address - Country:US
Practice Address - Phone:410-744-5937
Practice Address - Fax:410-744-4674
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2864101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X
MDLCA1577101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCA1577OtherLCADC
MDLC2864OtherLCPC