Provider Demographics
NPI:1306911078
Name:JOHNSTON, DOUGLASS DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:DOUGLASS
Middle Name:DAVID
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:114 MAIN STREET
Mailing Address - City:WYALUSING
Mailing Address - State:PA
Mailing Address - Zip Code:18853-0174
Mailing Address - Country:US
Mailing Address - Phone:570-746-6003
Mailing Address - Fax:570-746-2011
Practice Address - Street 1:111 FRONT ST
Practice Address - Street 2:
Practice Address - City:WYALUSING
Practice Address - State:PA
Practice Address - Zip Code:18853-7505
Practice Address - Country:US
Practice Address - Phone:570-746-6003
Practice Address - Fax:570-746-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW000365E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW000365EOtherSOCIAL WORK