Healthcare Provider Details

I. General information

NPI: 1336503200
Provider Name (Legal Business Name): MARCIA G WALTON MS. CSAC, CS-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA G VILLA

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 6TH ST
MILWAUKEE WI
53204-2301
US

IV. Provider business mailing address

1028 S 9TH ST
MILWAUKEE WI
53204-1395
US

V. Phone/Fax

Practice location:
  • Phone: 414-643-8530
  • Fax:
Mailing address:
  • Phone: 414-643-8530
  • Fax: 414-647-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17620
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3497 - 226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: