Provider Demographics
NPI:1780332668
Name:GEORGE, SHAWN M (LPC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 OTELIA CT
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4561
Mailing Address - Country:US
Mailing Address - Phone:434-258-8642
Mailing Address - Fax:
Practice Address - Street 1:101 NORTHWYND CIR STE D
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3140
Practice Address - Country:US
Practice Address - Phone:434-258-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional