Individual
MS. GEORGEANN THELMA HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, LISAC
Contact information
Practice address
5 SAN CARLOS AVE., SAN CARLOS, AZ 85550-9900
(928) 475-4875
(928) 475-4880
Mailing address
5 SAN CARLOS AVE., SAN CARLOS, AZ 85550-9900
(928) 475-4875
(928) 475-4880
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10819
AZ
104100000X
Social Worker
LMSW-11182
AZ
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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