Provider Demographics
NPI:1194275313
Name:GEORGE, WILLIAM GARY JR (LMFT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GARY
Last Name:GEORGE
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 N 20TH ST.
Mailing Address - Street 2:GRACE UNITED METHODIST CHURCH
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19138
Mailing Address - Country:US
Mailing Address - Phone:215-530-1794
Mailing Address - Fax:215-948-3627
Practice Address - Street 1:7101 N 20TH ST.
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19138
Practice Address - Country:US
Practice Address - Phone:215-530-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist