Provider Demographics
NPI:1902672694
Name:ROSSI, GEORGE M (LPC/A)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:ROSSI
Suffix:
Gender:M
Credentials:LPC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 HIDDEN POND CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8299
Mailing Address - Country:US
Mailing Address - Phone:803-221-1160
Mailing Address - Fax:
Practice Address - Street 1:632 HIDDEN POND CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8299
Practice Address - Country:US
Practice Address - Phone:803-221-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional