Provider Demographics
NPI:1104373323
Name:DRUMMY, MARCY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:DRUMMY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2075
Mailing Address - Country:US
Mailing Address - Phone:262-284-5789
Mailing Address - Fax:262-284-5907
Practice Address - Street 1:1317 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2075
Practice Address - Country:US
Practice Address - Phone:262-284-5789
Practice Address - Fax:262-284-5907
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6026-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional