Provider Demographics
NPI:1053734046
Name:GEORGE, DORIC (MA, MFT, LPCC)
Entity type:Individual
Prefix:MR
First Name:DORIC
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MA, MFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD UNIT 771
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-717-1771
Mailing Address - Fax:
Practice Address - Street 1:23545 CRENSHAW BLVD STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5253
Practice Address - Country:US
Practice Address - Phone:310-717-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC208101Y00000X
CAMFC38343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor