Provider Demographics
NPI:1942930045
Name:WEATHERS, MARCUS JR (CRC, LPC-IT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:WEATHERS
Suffix:JR
Gender:M
Credentials:CRC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 OFFSHORE DR APT 314
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4386
Mailing Address - Country:US
Mailing Address - Phone:608-772-2453
Mailing Address - Fax:
Practice Address - Street 1:5930 SEMINOLE CENTRE CT STE C
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5165
Practice Address - Country:US
Practice Address - Phone:608-630-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor