Provider Demographics
NPI:1316715543
Name:GEORGE, TAMARA ROSE (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ROSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 SPRINGHILL RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-2152
Mailing Address - Country:US
Mailing Address - Phone:814-241-8162
Mailing Address - Fax:
Practice Address - Street 1:325 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4133
Practice Address - Country:US
Practice Address - Phone:734-762-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional