MEDICARE: MS. DIANE MARIE GILLIARD LCPC, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13726	IL
2	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1609984285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE MARIE GILLIARD LCPC, CADC

Provider Business Mailing Address
First Line	:	714 S FAIRFIELD AVE
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-3504
Country	:	US
Telephone Number	:	630-620-4327
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S MARION ST
Second Line	:	4TH FLOOR
City	:	OAK PARK
State	:	IL
Zip	:	60302-2809
Country	:	US
Telephone Number	:	708-406-3105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/11/2025

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