Provider Demographics
NPI:1609200369
Name:GEORGE, SHARLENE (PC)
Entity Type:Individual
Prefix:MS
First Name:SHARLENE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 DRESSLER RD NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2543
Mailing Address - Country:US
Mailing Address - Phone:330-818-0663
Mailing Address - Fax:330-493-3689
Practice Address - Street 1:4895 DRESSLER RD NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2543
Practice Address - Country:US
Practice Address - Phone:330-818-0663
Practice Address - Fax:330-493-3689
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1200129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health