Georgeann Thelma Hendricks, LMSW, LISAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LISAC-10819 Issued in AZ

Practice address

5 San Carlos Ave.
San Carlos, AZ 85550-9900

Phone

(928) 475-4875

Fax

(928) 475-4880

NPI assigned

Jan 9, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• San Carlos Apache Tribe

  dba Wellness Center

  • Community/Behavioral Health Agency
  • San Carlos, AZ
  • NPI 1750456307
  NPD (past)
• San Carlos Apache Wellness Center

  • Community/Behavioral Health Agency
  • San Carlos, AZ
  • NPI 1043761182
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1659641603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SAN CARLOS AVE.",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "855509900",
            "telephone_number": "928-475-4875",
            "fax_number": "928-475-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SAN CARLOS AVE.",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "855509900",
            "telephone_number": "928-475-4875",
            "fax_number": "928-475-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "GEORGEANN",
        "middle_name": "THELMA",
        "name_prefix": "Ms.",
        "credential": "LMSW, LISAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-09",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-10819",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "LMSW-11182",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Wesley Eaton, DO
• William John Esposito, DMD
• Teresa Gallenstein, PHD
• Patricia Rosa Hamrick, PSY.D.
• Karen Sue Heath, M.D.
• Robert Reed Henley, PH.D.
• Michael E. Hudson, M.D.
• Julia Whitener Jones, RPH
• Chul H. Kim, M.D.
• Raven Kitcheyan

• Addiction (Substance Use Disorder) Counselor in San Carlos, AZ
• Providers in San Carlos, AZ by specialty
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.