Provider Demographics
NPI:1679621742
Name:SAKASH, GEORGE J (LICDC, LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:SAKASH
Suffix:
Gender:M
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1424
Mailing Address - Country:US
Mailing Address - Phone:419-294-1212
Mailing Address - Fax:419-294-6336
Practice Address - Street 1:102 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1424
Practice Address - Country:US
Practice Address - Phone:419-294-1212
Practice Address - Fax:419-294-6336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83868101YP2500X
OHC-1862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional