Provider Demographics
NPI:1669752465
Name:JOHNSTON, MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:SHORTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18278 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-8380
Mailing Address - Country:US
Mailing Address - Phone:814-332-0095
Mailing Address - Fax:814-746-3994
Practice Address - Street 1:18278 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-8380
Practice Address - Country:US
Practice Address - Phone:814-332-0095
Practice Address - Fax:814-746-3994
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional