Provider Demographics
NPI:1619637550
Name:GEORGE, SHON D (LMSW, MA, MDIV)
Entity Type:Individual
Prefix:
First Name:SHON
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LMSW, MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W CHESTNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-1662
Mailing Address - Country:US
Mailing Address - Phone:302-222-6831
Mailing Address - Fax:
Practice Address - Street 1:508 W CHESTNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:DE
Practice Address - Zip Code:19962-1662
Practice Address - Country:US
Practice Address - Phone:302-222-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
DEQ3-0010656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral