Provider Demographics
NPI:1104148212
Name:JOHNSTON, CANDIE
Entity type:Individual
Prefix:
First Name:CANDIE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4090
Mailing Address - Country:US
Mailing Address - Phone:931-503-4600
Mailing Address - Fax:931-503-4620
Practice Address - Street 1:901 MARTIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4090
Practice Address - Country:US
Practice Address - Phone:931-503-4600
Practice Address - Fax:931-503-4620
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker