Individual
MARY M JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCW
Contact information
Practice address
2113 STATE ST, 1ST FLOOR, NEW ALBANY, IN 47150-4961
(812) 949-3505
(812) 949-3505
Mailing address
1116 LAVISTA WAY, LOUISVILLE, KY 40219-2618
(502) 969-2009
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3380
KY
1041C0700X
Clinical Social Worker
34004819A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200189820A
—
IN
Enumeration date
07/14/2006
Last updated
02/21/2020
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