Provider Demographics
NPI:1003781519
Name:SCRUGGS, MARCEIA
Entity type:Individual
Prefix:
First Name:MARCEIA
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18141 DIXIE HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2242
Mailing Address - Country:US
Mailing Address - Phone:708-991-7901
Mailing Address - Fax:
Practice Address - Street 1:18141 DIXIE HWY STE 115
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2242
Practice Address - Country:US
Practice Address - Phone:708-991-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health