Provider Demographics
NPI:1659818821
Name:GEORGE, JOHN W III (LMSW,CAADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GEORGE
Suffix:III
Gender:M
Credentials:LMSW,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23505 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1968
Mailing Address - Country:US
Mailing Address - Phone:586-701-2997
Mailing Address - Fax:
Practice Address - Street 1:23505 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1968
Practice Address - Country:US
Practice Address - Phone:586-701-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011159011041C0700X
MI6801107233104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker