Provider Demographics
NPI:1013244151
Name:POLK, GEORGE REGINALD (LPC; LMHC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:REGINALD
Last Name:POLK
Suffix:
Gender:M
Credentials:LPC; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 N COURSE DR APT 305
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3370
Mailing Address - Country:US
Mailing Address - Phone:703-577-4389
Mailing Address - Fax:954-366-3539
Practice Address - Street 1:3095 N COURSE DR APT 305
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3370
Practice Address - Country:US
Practice Address - Phone:170-357-7438
Practice Address - Fax:954-366-3539
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17414101YM0800X
VA0701004680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health