Healthcare Provider Details

I. General information

NPI: 1477406916
Provider Name (Legal Business Name): MARINA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE 340
STUART FL
34994-3502
US

IV. Provider business mailing address

1724 SE WASHINGTON ST N
STUART FL
34997-5892
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: