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General NPI Number Information
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NPI Number | 1033939681
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Entity Type | Organization
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Legal Business Name | THE SILENTMARCK EMPOWERMENT CENTER, LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 6761 NW ELAINE ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1408
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Country | US
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Telephone | 772-577-0981
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Fax | 772-521-8071
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Provider Business Mailing Address
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Address Line | 2609 S FEDERAL HWY # 1116
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City | FORT PIERCE
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State | FL
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Zip | 34982-5923
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Country | US
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Telephone | 772-577-0981
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Fax | 772-521-8071
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. MARCKDALINE JOHNSON
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Credential | PHD, LCSW
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Telephone | 772-577-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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