Provider Demographics
NPI:1306915269
Name:DUNCAN-HIVELY, GEORGIANNE DELL (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:GEORGIANNE
Middle Name:DELL
Last Name:DUNCAN-HIVELY
Suffix:
Gender:F
Credentials:PHD, JD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:DELL
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, JD
Mailing Address - Street 1:PMB 286
Mailing Address - Street 2:1324 CLARKSON CLAYTON CENTER
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:314-580-5346
Mailing Address - Fax:636-398-6845
Practice Address - Street 1:300 OZARK TRAIL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2166
Practice Address - Country:US
Practice Address - Phone:314-580-5346
Practice Address - Fax:636-398-6845
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD1007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical