Provider Demographics
NPI:1780639278
Name:JOHNSTON, JULIA B (MSW, LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:B
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW, BCD
Mailing Address - Street 1:1203 BAHAMA RD
Mailing Address - Street 2:
Mailing Address - City:BAHAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27503-9017
Mailing Address - Country:US
Mailing Address - Phone:919-286-1920
Mailing Address - Fax:
Practice Address - Street 1:1203 BAHAMA RD
Practice Address - Street 2:
Practice Address - City:BAHAMA
Practice Address - State:NC
Practice Address - Zip Code:27503-9017
Practice Address - Country:US
Practice Address - Phone:919-286-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002106Medicaid
NC60233OtherBLUE CROSS BLUE SHIELD
277696000OtherMAGELLAN BEHAVIORAL HEALT
131084OtherVALUE OPTIONS
7670351OtherAETNA HEALTH INSURANCE