Provider Demographics
NPI:1669541769
Name:GADLAGE, BELVA J (LCPC)
Entity type:Individual
Prefix:
First Name:BELVA
Middle Name:J
Last Name:GADLAGE
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 1:2570 FEDERAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-872-1003
Mailing Address - Fax:217-233-4150
Practice Address - Street 1:2570 FEDERAL DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-872-1003
Practice Address - Fax:217-233-4150
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
05821971OtherBCBS
05821971OtherBCBS
IL200908Medicare ID - Type Unspecified