Marina Gordula Johnson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C009623 Issued in NC

Practice address

2005 Hope Mills Rd
Fayetteville, NC 28304-4224

Phone

(910) 920-5802

Fax

(910) 491-3884

NPI assigned

Jun 17, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Purple Paws, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fayetteville, NC
  • NPI 1467184663
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1134568801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044224",
            "telephone_number": "910-920-5802",
            "fax_number": "910-491-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044224",
            "telephone_number": "910-920-5802",
            "fax_number": "910-491-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARINA",
        "middle_name": "GORDULA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-17",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C009623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302263",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Pitts Johnson, LCSW
• Lisa S Johnson, DNP, MSN, RN
• Maceyn Johnson
• Marceal Schipper Johnson, CNM
• Marilyn Little Johnson, CCC-SLP
• Marva E Johnson, LPC
• Nichole Lushawn Johnson, LCSW, LCAS
• Octavia Armond Johnson, RBT
• Olga Khodakova Johnson, M.D.
• Oliver James Johnson, PH.D., LCSW

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.