Provider Demographics
NPI:1710211164
Name:JOHNSTON, CHRISTOPHER NEVIN
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:NEVIN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S E ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4794
Mailing Address - Country:US
Mailing Address - Phone:707-478-5598
Mailing Address - Fax:
Practice Address - Street 1:144 S E ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4794
Practice Address - Country:US
Practice Address - Phone:707-478-5598
Practice Address - Fax:707-571-5531
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710211164Medicaid