MEDICARE: MS. MARCELLA SYVILLE ADKINS LPC, SAC-IT

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	101YP2500X	Professional Counselor	4059-125	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	14841-130	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659404309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCELLA SYVILLE ADKINS LPC, SAC-IT

Provider Business Mailing Address
First Line	:	6001 W CENTER ST
Second Line	:	SUITE 208
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-393-1099
Fax Number	:	414-393-9773

Provider Business Practice Location Address
First Line	:	6001 W CENTER ST
Second Line	:	SUITE 208
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-393-1099
Fax Number	:	414-393-7993

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	10/26/2010

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