Provider Demographics
NPI:1699841825
Name:JOHNSTON, GRACE GRINDLE (LCSW, LCAS)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:GRINDLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MARY LEE CT
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9917
Mailing Address - Country:US
Mailing Address - Phone:252-814-9191
Mailing Address - Fax:252-355-7947
Practice Address - Street 1:704 CROMWELL DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5894
Practice Address - Country:US
Practice Address - Phone:252-814-9191
Practice Address - Fax:252-355-7947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052911041C0700X
NC1077101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143K1OtherBCBS
NC6106386Medicaid
NC190827OtherMEDCOST