Provider Demographics
NPI:1205432911
Name:MCGINNIS ROBERTS, GEORGIA (LCSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:MCGINNIS ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8639 SW LIZZIE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7097
Mailing Address - Country:US
Mailing Address - Phone:503-449-8295
Mailing Address - Fax:
Practice Address - Street 1:7100 SW HAMPTON ST STE 223
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8364
Practice Address - Country:US
Practice Address - Phone:503-342-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL74911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical