Provider Demographics
NPI:1831230549
Name:JOHNSTONE, KENNETH M (MSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:M
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 MADISON AVE
Mailing Address - Street 2:B105 KEN JOHNSTONE LCSW MFCC
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610
Mailing Address - Country:US
Mailing Address - Phone:916-967-0611
Mailing Address - Fax:916-967-4535
Practice Address - Street 1:7509 MADISON AVE
Practice Address - Street 2:B105 KEN JOHNSTONE LCSW MFCC
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:916-967-0611
Practice Address - Fax:916-967-4535
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 10780104100000X
CAMFC9327106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist