Provider Demographics
NPI:1639407463
Name:MICKEY, GEORGE HAROLD (MA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HAROLD
Last Name:MICKEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 WILLOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-7311
Mailing Address - Country:US
Mailing Address - Phone:831-277-8143
Mailing Address - Fax:
Practice Address - Street 1:877 WILLOWDALE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-7311
Practice Address - Country:US
Practice Address - Phone:681-209-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical