| Doctor Name: | MR. GEORGE PAUL THOTTAKARA |
| NPI Number: | 1013006329 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA CADC III |
| License Number: | 2579125 |
| Business Practice Address: | 1201 Jackson St Marinette County Health And Human Services Niagara, WI - 54151 |
| Business Phone Number: | 7152514555 |
| Business Fax Number: | 7152511754 |
| Mailing Address: | 2500 Hall Ave, Suite A Marinette County Health And Human Services MARINETTE |
| State: | WI |
| Postal Code: | 54143 |
| Phone Number: | 7157327760 |
| Fax Number: | 7157327711 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2579125 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |