Healthcare Provider Details

I. General information

NPI: 1265807309
Provider Name (Legal Business Name): MANUELA C MARIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 ENGLENOOK DR
DEBARY FL
32713-1803
US

IV. Provider business mailing address

352 ENGLENOOK DR
DEBARY FL
32713-1803
US

V. Phone/Fax

Practice location:
  • Phone: 407-732-7266
  • Fax:
Mailing address:
  • Phone: 407-732-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: