Provider Demographics
NPI:1013985712
Name:JOHNSTON, EDWARD RICHARDS III (LPA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:RICHARDS
Last Name:JOHNSTON
Suffix:III
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8570
Mailing Address - Country:US
Mailing Address - Phone:828-329-9670
Mailing Address - Fax:
Practice Address - Street 1:111 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4409
Practice Address - Country:US
Practice Address - Phone:828-412-3144
Practice Address - Fax:828-782-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1866103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0454AOtherBCBS OF NC
NC6107299Medicaid
NCN/AOtherCBHA
NCN/AOtherCBHA