Provider Demographics
NPI:1851619639
Name:JOHNSTON, ROSALIE NADINE (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:NADINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W IRONWOOD DR
Mailing Address - Street 2:STE#2
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2644
Mailing Address - Country:US
Mailing Address - Phone:208-664-1594
Mailing Address - Fax:208-664-5867
Practice Address - Street 1:950 W IRONWOOD DR
Practice Address - Street 2:STE #2
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2644
Practice Address - Country:US
Practice Address - Phone:208-664-1594
Practice Address - Fax:208-664-5867
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health