Provider Demographics
NPI:1619942141
Name:JOHNSTON, MARY (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 CORPORATE WOODS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4376
Mailing Address - Country:US
Mailing Address - Phone:757-473-3770
Mailing Address - Fax:757-473-3768
Practice Address - Street 1:5029 CORPORATE WOODS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4376
Practice Address - Country:US
Practice Address - Phone:757-473-3770
Practice Address - Fax:757-473-3768
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health