Provider Demographics
NPI:1497299093
Name:JOHNSTON, CATHERINE NEELY
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:NEELY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:JEAN
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CNSC
Mailing Address - Street 1:118 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1247
Mailing Address - Country:US
Mailing Address - Phone:864-752-8402
Mailing Address - Fax:
Practice Address - Street 1:118 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1247
Practice Address - Country:US
Practice Address - Phone:864-752-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered