Provider Demographics
NPI:1669730842
Name:MAU, GEORGE FREDERIC (DMIN,MA,MDIV,L)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FREDERIC
Last Name:MAU
Suffix:
Gender:M
Credentials:DMIN,MA,MDIV,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BUSINESS PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9659
Mailing Address - Country:US
Mailing Address - Phone:803-759-2000
Mailing Address - Fax:
Practice Address - Street 1:245 BUSINESS PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9659
Practice Address - Country:US
Practice Address - Phone:803-759-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5489101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor