Provider Demographics
NPI:1578288601
Name:JOHNSTON, ANDY (PLPC)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 DUNBARTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5001
Mailing Address - Country:US
Mailing Address - Phone:601-982-5376
Mailing Address - Fax:
Practice Address - Street 1:1920 DUNBARTON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5001
Practice Address - Country:US
Practice Address - Phone:601-982-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor