Provider Demographics
NPI:1487048070
Name:GEORGE, DOUGLAS ULYSSES (ASW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ULYSSES
Last Name:GEORGE
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 VIA BUENA
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2052
Mailing Address - Country:US
Mailing Address - Phone:909-706-7288
Mailing Address - Fax:
Practice Address - Street 1:1025 SENTINEL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3280
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:909-833-2998
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW65434104100000X
CA938301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker