Provider Demographics
NPI:1881836302
Name:JOHNSTON, LISA MICHELLE (CAS# 8492)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CAS# 8492
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1025
Mailing Address - Country:US
Mailing Address - Phone:925-676-4840
Mailing Address - Fax:925-676-1315
Practice Address - Street 1:2931 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1025
Practice Address - Country:US
Practice Address - Phone:925-676-4840
Practice Address - Fax:925-676-1315
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS #8492101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4293520OtherDMV