Provider Demographics
NPI:1295306694
Name:RANKINS, MARVIN (LPCIT,CSAC,ICSIT,LPS)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:RANKINS
Suffix:
Gender:M
Credentials:LPCIT,CSAC,ICSIT,LPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W CLEVELAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2956
Mailing Address - Country:US
Mailing Address - Phone:414-269-8356
Mailing Address - Fax:414-455-1915
Practice Address - Street 1:2727 W CLEVELAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2956
Practice Address - Country:US
Practice Address - Phone:414-269-8356
Practice Address - Fax:414-455-1915
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)