Individual
KELLEY A JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
147 ACADEMY ST, PRESQUE ISLE, ME 04769-3101
(207) 764-6825
(207) 764-6077
Mailing address
PO BOX 509, PRESQUE ISLE, ME 04769-0509
(207) 764-6825
(207) 764-6077
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC3787
ME
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC4577
ME
101YM0800X
Mental Health Counselor
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740476159
—
ME
Enumeration date
09/19/2007
Last updated
10/07/2019
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