Healthcare Provider Details

I. General information

NPI: 1114565595
Provider Name (Legal Business Name): DIONNE GERFEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 DOMINOE TRL
FOLEY AL
36535-9472
US

IV. Provider business mailing address

10257 STATE ROUTE 3
RED BUD IL
62278-4418
US

V. Phone/Fax

Practice location:
  • Phone: 618-973-6705
  • Fax:
Mailing address:
  • Phone: 618-282-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180013094
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: