Basic Information
| Provider Information | |||||||||
| NPI: | 1861742967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCREA | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPC, CADCIII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 SE DOUGLAS ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973654427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412640230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51 SW LEE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973653823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415745960 | ||||||||
| FaxNumber: | 5412650601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2012 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C3502 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 13-09-77 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | C3502 | 01 | OR | LPC | OTHER | 13-09-77 | 01 | OR | CADCIII | OTHER |