Provider Demographics
NPI:1669543146
Name:JOHNSTON, CARRIE LYNN (MA, TLLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NOTRE DAME CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2554
Mailing Address - Country:US
Mailing Address - Phone:248-787-6243
Mailing Address - Fax:
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1591
Practice Address - Country:US
Practice Address - Phone:810-227-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical