Provider Demographics
NPI:1689905093
Name:GEORGE, TAMMY M (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:M
Other - Last Name:CAKOUROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20188-0371
Mailing Address - Country:US
Mailing Address - Phone:703-380-8764
Mailing Address - Fax:703-745-9130
Practice Address - Street 1:92 MAIN ST
Practice Address - Street 2:SUITE 202-6
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3366
Practice Address - Country:US
Practice Address - Phone:703-380-8764
Practice Address - Fax:703-745-9130
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2023-10-13
Deactivation Date:2020-08-07
Deactivation Code:
Reactivation Date:2023-10-13
Provider Licenses
StateLicense IDTaxonomies
VA09040072941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945247Medicaid
VA004945247Medicaid