Provider Demographics
NPI:1730200932
Name:GEORGE, LAURA JEAN (DSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 24TH ST NW STE 12
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2592
Mailing Address - Country:US
Mailing Address - Phone:202-491-3405
Mailing Address - Fax:202-296-9619
Practice Address - Street 1:730 24TH ST NW STE 12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-491-3405
Practice Address - Fax:202-296-9619
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3032931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491240Medicare ID - Type Unspecified