Individual
GREGORY IRWIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3416 LIBERTY DR, SPRINGFIELD, IL 62704-6520
(217) 793-3949
Mailing address
3416 LIBERTY DR, SPRINGFIELD, IL 62704-6520
(217) 793-3949
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.012265
IL
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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