Provider Demographics
NPI:1912518556
Name:JOHNSTON, ROSS ADAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ADAM
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N 3RD ST APT 125
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3577
Mailing Address - Country:US
Mailing Address - Phone:302-290-9872
Mailing Address - Fax:
Practice Address - Street 1:5015 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7016
Practice Address - Country:US
Practice Address - Phone:910-777-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical