Provider Demographics
NPI:1306111018
Name:WASSELL, GEORGE JR (MS, LPC, CEAP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WASSELL
Suffix:JR
Gender:M
Credentials:MS, LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3056
Mailing Address - Country:US
Mailing Address - Phone:203-520-2770
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-5782
Practice Address - Fax:203-375-3048
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional