MEDICARE: MARGARET CHERIE POLVI LPC-S, LMSW, LCDC

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	4529	TX
2	101YP2500X	Professional Counselor	9287	TX
3	104100000X	Social Worker	12912	TX

General Provider Information

NPI Number	:	1790059871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET CHERIE POLVI LPC-S, LMSW, LCDC

Provider Business Mailing Address
First Line	:	4817 CRESTPOINT LN
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-6514
Country	:	US
Telephone Number	:	972-226-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 CRESTPOINT LN
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-6514
Country	:	US
Telephone Number	:	972-226-2341
Fax Number	:

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

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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