Provider Demographics
NPI:1437489317
Name:JOHNSTON, CARRIE LORENE (LPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LORENE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 W KINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2442
Mailing Address - Country:US
Mailing Address - Phone:972-804-2707
Mailing Address - Fax:
Practice Address - Street 1:2722 W KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2442
Practice Address - Country:US
Practice Address - Phone:972-804-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional