| Doctor Name: | JACLYNN GEORGE |
| NPI Number: | 1013381797 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.L.P.C. |
| License Number: | 6401014867 |
| Business Practice Address: | 2501 Rochester Ct Troy, MI - 480831875 |
| Business Phone Number: | 2482660453 |
| Business Fax Number: | |
| Mailing Address: | 3177 Newbury Pl, TROY |
| State: | MI |
| Postal Code: | 480847033 |
| Phone Number: | 2482660453 |
| Fax Number: | |
| NPI Enumeration Date: | 11/18/2015 |
| NPI Last Update Date: | 11/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401014867 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |