Provider Demographics
NPI:1558839001
Name:JOHNSTON, AMY NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BRANNON RD, BLDG 674
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857
Mailing Address - Country:US
Mailing Address - Phone:808-433-9266
Mailing Address - Fax:808-433-8597
Practice Address - Street 1:315 BRANNON RD, BLDG 674
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-9266
Practice Address - Fax:808-433-8597
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical