Provider Demographics
NPI:1659404309
Name:ADKINS, MARCELLA SYVILLE (LPC, SAC-IT)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:SYVILLE
Last Name:ADKINS
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W CENTER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2154
Mailing Address - Country:US
Mailing Address - Phone:414-393-1099
Mailing Address - Fax:414-393-9773
Practice Address - Street 1:6001 W CENTER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2154
Practice Address - Country:US
Practice Address - Phone:414-393-1099
Practice Address - Fax:414-393-7993
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4059-125101YP2500X
WI14841-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43725300Medicaid