Provider Demographics
NPI:1699743286
Name:WOLCOTT, GEORGE M (LPC, LMFT, EDD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:LPC, LMFT, EDD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:M
Other - Last Name:WOLCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LMFT, EDD
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:STE. 570
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-221-4455
Mailing Address - Fax:318-221-4459
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:STE. 570
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-221-4455
Practice Address - Fax:318-221-4459
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106101YP2500X
LA15106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10Medicare UPIN