Provider Demographics
NPI:1568602423
Name:JOHNSTON, LEROY NOBLE JR (PH D)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:NOBLE
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9306
Mailing Address - Country:US
Mailing Address - Phone:717-627-2018
Mailing Address - Fax:
Practice Address - Street 1:617 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9306
Practice Address - Country:US
Practice Address - Phone:717-627-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006205L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical