Provider Demographics
NPI:1235477464
Name:TSAFTARIDES, GEORGIA (LPCC-S)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:TSAFTARIDES
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 COCKLEBURR ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1923
Mailing Address - Country:US
Mailing Address - Phone:321-622-0355
Mailing Address - Fax:330-491-0614
Practice Address - Street 1:5208 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1806
Practice Address - Country:US
Practice Address - Phone:321-622-0355
Practice Address - Fax:330-491-0614
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional