Provider Demographics
NPI:1306139704
Name:JOHNSTON, ALISA LOUISE (LPC, NCC, LSW)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LOUISE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC, NCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157
Mailing Address - Country:US
Mailing Address - Phone:601-977-9353
Mailing Address - Fax:601-977-9422
Practice Address - Street 1:361 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 1300
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:601-977-9422
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1254101YP2500X
MSW4620104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker