Provider Demographics
NPI:1750859989
Name:JOHNSTON, NEALY VICKER (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:NEALY
Middle Name:VICKER
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WINDING RIVER LN STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3644
Mailing Address - Country:US
Mailing Address - Phone:434-995-8863
Mailing Address - Fax:434-961-2556
Practice Address - Street 1:315 WINDING RIVER LN STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3644
Practice Address - Country:US
Practice Address - Phone:434-995-8863
Practice Address - Fax:434-961-2556
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional