Provider Demographics
NPI:1013340397
Name:JOHNSTON, PAIGE NANTZ (MA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NANTZ
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 1:2345 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8221
Mailing Address - Country:US
Mailing Address - Phone:443-622-8555
Mailing Address - Fax:
Practice Address - Street 1:723 S CHARLES ST STE 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3857
Practice Address - Country:US
Practice Address - Phone:443-622-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional