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General NPI Number Information
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NPI Number | 1073912606
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Entity Type | Organization
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Legal Business Name | SANDPIPER WELLNESS & THERAPY, LLC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 1405 SE GOLDTREE DR STE D
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7563
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Country | US
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Telephone | 772-800-3990
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Fax | 772-621-2977
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Provider Business Mailing Address
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Address Line | 1405 SE GOLDTREE DR STE D
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7563
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Country | US
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Telephone | 772-800-3990
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Fax | 772-621-2977
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. JOHN MARINO
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Credential |
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Telephone | 772-800-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5646277703302
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5646277703302
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5646277703302
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 5646277703302
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC10590
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License Number State | FL
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