Provider Demographics
NPI:1245781566
Name:GLORIA, CRISTINA (LCPC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:GLORIA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 SPRINGWHEAT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5649
Mailing Address - Country:US
Mailing Address - Phone:224-704-0909
Mailing Address - Fax:
Practice Address - Street 1:4249 E STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2045
Practice Address - Country:US
Practice Address - Phone:224-704-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional