Provider Demographics
NPI:1205304615
Name:FIORENTINO, GEORGINA (EDD, LCASA, BT)
Entity type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:
Last Name:FIORENTINO
Suffix:
Gender:F
Credentials:EDD, LCASA, BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 IMPATIEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7739
Mailing Address - Country:US
Mailing Address - Phone:917-841-7842
Mailing Address - Fax:
Practice Address - Street 1:2520 IMPATIEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7739
Practice Address - Country:US
Practice Address - Phone:917-841-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29107101YA0400X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty