Provider Demographics
NPI:1568255461
Name:PRINGLE, GEORTHANDRA KENLEEN (LCSW)
Entity type:Individual
Prefix:PROF
First Name:GEORTHANDRA
Middle Name:KENLEEN
Last Name:PRINGLE
Suffix:
Gender:F
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:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-2021
Mailing Address - Country:US
Mailing Address - Phone:916-577-0763
Mailing Address - Fax:
Practice Address - Street 1:2460 CLAY BANK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1655
Practice Address - Country:US
Practice Address - Phone:707-399-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA931931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical