Provider Demographics
NPI:1528087921
Name:JOHNSTON, LIZ B (LCSW)
Entity type:Individual
Prefix:MS
First Name:LIZ
Middle Name:B
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5932
Mailing Address - Country:US
Mailing Address - Phone:805-787-0106
Mailing Address - Fax:
Practice Address - Street 1:11549 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6471
Practice Address - Country:US
Practice Address - Phone:805-471-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002046OtherCT LCSW
CA18489OtherCA LCSW
CACSW184890Medicaid
CT002046OtherCT LCSW
CA18489OtherCA LCSW