Provider Demographics
NPI:1902165186
Name:GEORGE, MEGAN (LSW CADC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3608
Mailing Address - Country:US
Mailing Address - Phone:847-492-1778
Mailing Address - Fax:
Practice Address - Street 1:906 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3608
Practice Address - Country:US
Practice Address - Phone:847-492-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL150.015158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker