Provider Demographics
NPI:1407025216
Name:JOHNSTON, JANINE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:WANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:153 PAYNES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-5732
Mailing Address - Country:US
Mailing Address - Phone:404-683-4831
Mailing Address - Fax:
Practice Address - Street 1:101 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-3447
Practice Address - Country:US
Practice Address - Phone:770-437-7200
Practice Address - Fax:770-258-9128
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical