Provider Demographics
NPI:1346767928
Name:WINSTON, DENOTRA JOHNSON (LCMHC, LCASA)
Entity Type:Individual
Prefix:
First Name:DENOTRA
Middle Name:JOHNSON
Last Name:WINSTON
Suffix:
Gender:F
Credentials:LCMHC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3414
Mailing Address - Country:US
Mailing Address - Phone:910-733-0524
Mailing Address - Fax:
Practice Address - Street 1:910 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4243
Practice Address - Country:US
Practice Address - Phone:910-827-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty