Provider Demographics
NPI:1770877300
Name:SUICK, GEORGINA J (LMSW)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:J
Last Name:SUICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E SOUTHEAST LOOP 323 STE 120
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9623
Mailing Address - Country:US
Mailing Address - Phone:903-509-2040
Mailing Address - Fax:
Practice Address - Street 1:821 E SOUTHEAST LOOP 323 STE 120
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9623
Practice Address - Country:US
Practice Address - Phone:903-509-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37391171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator