Provider Demographics
NPI:1760136162
Name:JOHNSTON, CAROL J (APRN,PMH,BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:APRN,PMH,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 DASHER FARM CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-8205
Mailing Address - Country:US
Mailing Address - Phone:410-591-8731
Mailing Address - Fax:
Practice Address - Street 1:7000 DASHER FARM CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-8205
Practice Address - Country:US
Practice Address - Phone:410-591-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093428163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty