Provider Demographics
NPI:1386988319
Name:JOHNSTON, ANDREA REBECCA (LPCA, LCAS-P, MA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:REBECCA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPCA, LCAS-P, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N. CROATAN HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948
Mailing Address - Country:US
Mailing Address - Phone:252-305-6612
Mailing Address - Fax:252-449-4050
Practice Address - Street 1:2400 N. CROATAN HWY
Practice Address - Street 2:SUITE F
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948
Practice Address - Country:US
Practice Address - Phone:252-305-6612
Practice Address - Fax:252-449-4050
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3008-A101YA0400X
NCA9644101YM0800X, 101YP2500X
NCLPC9644101YP2500X, 101YM0800X
NCLCAS-A-3008-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health