Provider Demographics
NPI:1669044228
Name:JOHNSTON, SARA NICOLE (RBT-19-91755)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RBT-19-91755
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N OAKES ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7309
Mailing Address - Country:US
Mailing Address - Phone:253-929-4552
Mailing Address - Fax:
Practice Address - Street 1:805 N OAKES ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7309
Practice Address - Country:US
Practice Address - Phone:253-929-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-19-91755106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty