Provider Demographics
NPI:1033951348
Name:SMALL, GEORGIA NICHOLSON (PLPC)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:NICHOLSON
Last Name:SMALL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18282 MANCHAC PL S
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3371
Mailing Address - Country:US
Mailing Address - Phone:225-439-8420
Mailing Address - Fax:
Practice Address - Street 1:10935 PERKINS RD STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-3005
Practice Address - Country:US
Practice Address - Phone:225-384-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health