Provider Demographics
NPI:1386886091
Name:BRAVAKIS, GEORGE JAMES (LMSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JAMES
Last Name:BRAVAKIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2319
Mailing Address - Country:US
Mailing Address - Phone:864-898-5800
Mailing Address - Fax:864-898-5800
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2319
Practice Address - Country:US
Practice Address - Phone:864-898-5800
Practice Address - Fax:864-898-5800
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC54611041C0700X
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty