Provider Demographics
NPI:1134228612
Name:GEORGE, DWAYNE F (LCSW)
Entity type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:F
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 MYERS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3614
Mailing Address - Country:US
Mailing Address - Phone:951-358-4850
Mailing Address - Fax:951-358-4852
Practice Address - Street 1:3840 MYERS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3505
Practice Address - Country:US
Practice Address - Phone:951-358-4850
Practice Address - Fax:951-358-4852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS198541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical