Provider Demographics
NPI:1871651083
Name:JOHNSTON, CARMELLA RAE (MA)
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:RAE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1352
Mailing Address - Country:US
Mailing Address - Phone:925-687-0202
Mailing Address - Fax:
Practice Address - Street 1:1861 SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-1352
Practice Address - Country:US
Practice Address - Phone:925-687-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist