Provider Demographics
NPI:1720495575
Name:GEORGE, SALLY
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOSE FIGUERES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2022
Mailing Address - Country:US
Mailing Address - Phone:408-347-3104
Mailing Address - Fax:408-347-3121
Practice Address - Street 1:101 JOSE FIGUERES AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2022
Practice Address - Country:US
Practice Address - Phone:408-347-3104
Practice Address - Fax:408-347-3121
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health