Provider Demographics
NPI:1295147445
Name:CRUZ-VIRELLA, YANCY L (LCPC, CRC, LPC)
Entity type:Individual
Prefix:DR
First Name:YANCY
Middle Name:L
Last Name:CRUZ-VIRELLA
Suffix:
Gender:F
Credentials:LCPC, CRC, LPC
Other - Prefix:DR
Other - First Name:YANCY
Other - Middle Name:L
Other - Last Name:CRUZ-VIRELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCPC, CRC
Mailing Address - Street 1:PO BOX 3411
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3411
Mailing Address - Country:US
Mailing Address - Phone:787-372-4808
Mailing Address - Fax:
Practice Address - Street 1:310 S PLOVER DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2030
Practice Address - Country:US
Practice Address - Phone:787-372-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional