Healthcare Provider Details

I. General information

NPI: 1780332775
Provider Name (Legal Business Name): GEORGIA DEE WINSON M.S., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GEORGIA DEE CRAGGS

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 GREENBRIAR DR
SPRINGFIELD IL
62704-6421
US

IV. Provider business mailing address

2824 CENTENNIAL DR
SPRINGFIELD IL
62711-6386
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-3118
  • Fax:
Mailing address:
  • Phone: 217-787-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1800002805
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1800002805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: