| Doctor Name: | MR. GEORGE REGINALD POLK |
| NPI Number: | 1013244151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 0701004680 |
| Business Practice Address: | 4211 Walney Rd Cornerstones Chantilly, VA - 201512923 |
| Business Phone Number: | 7032277111 |
| Business Fax Number: | 7033221631 |
| Mailing Address: | 4211 Walney Rd, Cornerstones CHANTILLY |
| State: | VA |
| Postal Code: | 201512923 |
| Phone Number: | 7032277111 |
| Fax Number: | 7033221631 |
| NPI Enumeration Date: | 11/11/2009 |
| NPI Last Update Date: | 11/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0701004680 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |