Provider Demographics
NPI:1154705838
Name:GEORGE, SYNAVIA (LCSW)
Entity type:Individual
Prefix:
First Name:SYNAVIA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SYNAVIA
Other - Middle Name:
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4413 BLUE CLAY RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-6122
Mailing Address - Country:US
Mailing Address - Phone:202-247-0429
Mailing Address - Fax:
Practice Address - Street 1:4413 BLUE CLAY RD
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6122
Practice Address - Country:US
Practice Address - Phone:202-247-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500788061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical