Provider Demographics
NPI:1104057702
Name:GEORGE, DANIEL (LPC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:109 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2685
Mailing Address - Country:US
Mailing Address - Phone:870-247-3588
Mailing Address - Fax:870-247-2072
Practice Address - Street 1:109 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2685
Practice Address - Country:US
Practice Address - Phone:870-247-3588
Practice Address - Fax:870-247-2072
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1204051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health