Provider Demographics
NPI:1033939681
Name:THE SILENTMARCK EMPOWERMENT CENTER, LLC
Entity type:Organization
Organization Name:THE SILENTMARCK EMPOWERMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCKDALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:772-577-0981
Mailing Address - Street 1:2609 S FEDERAL HWY # 1116
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5923
Mailing Address - Country:US
Mailing Address - Phone:772-577-0981
Mailing Address - Fax:772-521-8071
Practice Address - Street 1:6761 NW ELAINE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1408
Practice Address - Country:US
Practice Address - Phone:772-577-0981
Practice Address - Fax:772-521-8071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SILENTMARCK EMPOWERMENT CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty