Provider Demographics
NPI:1477236552
Name:GURDIAN-MCCREA, MARIA D (LCPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:GURDIAN-MCCREA
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 1:942 W TRAILCREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1864
Mailing Address - Country:US
Mailing Address - Phone:309-696-5119
Mailing Address - Fax:
Practice Address - Street 1:942 W TRAILCREEK DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1864
Practice Address - Country:US
Practice Address - Phone:309-696-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health