Provider Demographics
NPI:1750506572
Name:ST CLAIR, GEORGE W JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:ST CLAIR
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0787
Mailing Address - Country:US
Mailing Address - Phone:207-667-0909
Mailing Address - Fax:207-667-6348
Practice Address - Street 1:324 GANNETT DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-771-5700
Practice Address - Fax:207-771-5750
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker