Provider Demographics
NPI:1912293747
Name:GEORGE, ALEXIS KRISTEN (LCSW, LAADC)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:KRISTEN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LCSW, LAADC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:KRISTEN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3132 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4421
Mailing Address - Country:US
Mailing Address - Phone:619-683-3100
Mailing Address - Fax:
Practice Address - Street 1:3132 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4421
Practice Address - Country:US
Practice Address - Phone:619-683-3100
Practice Address - Fax:619-682-4037
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665921041C0700X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health