Provider Demographics
NPI:1811488828
Name:GROOMS ALBERTO, MEGAN DIANE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:DIANE
Last Name:GROOMS ALBERTO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5758 ELAINE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3102
Mailing Address - Country:US
Mailing Address - Phone:815-975-1177
Mailing Address - Fax:815-668-8931
Practice Address - Street 1:5758 ELAINE DR STE 112
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3102
Practice Address - Country:US
Practice Address - Phone:815-975-1177
Practice Address - Fax:815-668-8931
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013365101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional