Active NPI
Mary Miceli-Wink, CSAC
- Addiction (Substance Use Disorder) Counselor
- Green Bay, WI
National Provider Identifier
1205167426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1198
- Practice address
- 3150 Gershwin Drive
Green Bay, WI 54311-5859 - Phone
- (920) 391-6940
- Fax
- (920) 391-4870
- NPI assigned
- Jan 28, 2010
- Last updated
- Jan 28, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1198 | WI | Primary |
Addresses
Primary practice location
3150 Gershwin Drive
Green Bay, WI 54311-5859
Mailing address
3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone (920) 391-6940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1198 | WI | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264636800000",
"number": "1205167426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 GERSHWIN DRIVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115859",
"telephone_number": "920-391-6940",
"fax_number": "920-391-4870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 GERSHWIN DRIVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115859",
"telephone_number": "920-391-6940",
"fax_number": "920-391-4870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICELI-WINK",
"first_name": "MARY",
"credential": "CSAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-28",
"last_updated": "2010-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.