Provider Demographics
NPI:1942412960
Name:JOHNSTON, SUSAN HOLYOKE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HOLYOKE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11428 WATERVIEW CLUSTER
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4313
Mailing Address - Country:US
Mailing Address - Phone:703-787-8066
Mailing Address - Fax:
Practice Address - Street 1:11428 WATERVIEW CLUSTER
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4313
Practice Address - Country:US
Practice Address - Phone:703-787-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040000781041C0700X
MD002041041C0700X
DCLC3004961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical