Provider Demographics
NPI:1679846232
Name:GEORGE, JODIE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 COTTAGE WAY
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1225
Mailing Address - Country:US
Mailing Address - Phone:926-482-4901
Mailing Address - Fax:
Practice Address - Street 1:2701 COTTAGE WAY
Practice Address - Street 2:SUITE 22
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1225
Practice Address - Country:US
Practice Address - Phone:926-482-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist