Provider Demographics
NPI:1942469648
Name:JOHNSTON, JOHN DRUILHETT III (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DRUILHETT
Last Name:JOHNSTON
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 GRAND OAK CIR
Mailing Address - Street 2:APT 104
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7135
Mailing Address - Country:US
Mailing Address - Phone:207-446-6123
Mailing Address - Fax:
Practice Address - Street 1:6326 GRAND OAK CIR
Practice Address - Street 2:APT 104
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7135
Practice Address - Country:US
Practice Address - Phone:207-446-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC59461041C0700X
FLSW176011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME223830099Medicaid