Provider Demographics
NPI:1013507318
Name:JOHNSTON, NICOLAS T (RBT)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:T
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 PLANTATION RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5713
Mailing Address - Country:US
Mailing Address - Phone:434-420-2027
Mailing Address - Fax:
Practice Address - Street 1:1320 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:434-420-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-134088106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician