Provider Demographics
NPI:1295590511
Name:OMAN, GEOFFREY ALAN
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:OMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEOFF
Other - Middle Name:
Other - Last Name:OMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 SWAMP ROSE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7587
Mailing Address - Country:US
Mailing Address - Phone:815-222-3289
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 770
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3142
Practice Address - Country:US
Practice Address - Phone:783-445-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional