Provider Demographics
NPI:1396982039
Name:SGOUROS, GEORGIA TINA (LCSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:TINA
Last Name:SGOUROS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 SUNSET RIDGE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6677
Mailing Address - Country:US
Mailing Address - Phone:919-274-2970
Mailing Address - Fax:
Practice Address - Street 1:3921 SUNSET RIDGE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6677
Practice Address - Country:US
Practice Address - Phone:919-274-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0062721041C0700X
NC13097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No183500000XPharmacy Service ProvidersPharmacist