Provider Demographics
NPI:1205335387
Name:JOHNSTON, KRISTINA L (CDP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4672
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0672
Mailing Address - Country:US
Mailing Address - Phone:509-456-5465
Mailing Address - Fax:509-456-5710
Practice Address - Street 1:1321 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2803
Practice Address - Country:US
Practice Address - Phone:509-327-3120
Practice Address - Fax:509-327-3228
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60344329Medicaid