Individual
GEORGE M ENNELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
224 GREAT BRIDGE BLVD, CITY OF CHESAPEAKE TA CHESAPEAKE COMM. SERV. BOARD, CHESAPEAKE, VA 23320-3904
(757) 547-9334
(757) 819-6292
Mailing address
224 GREAT BRIDGE BLVD, CITY OF CHESAPEAKE TA CHESAPEAKE COMM. SERV. BOARD, CHESAPEAKE, VA 23320-3904
(757) 547-9334
(757) 819-6292
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000980
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088100
TRIGON
VA
01
—
325673
MAMSI
VA
Enumeration date
11/16/2006
Last updated
12/24/2009
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