Healthcare Provider Details

I. General information

NPI: 1265772172
Provider Name (Legal Business Name): STEFANIE J. JOHNSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PARKSTONE CIR
NORTH LITTLE ROCK AR
72116-7086
US

IV. Provider business mailing address

14 PARKSTONE CIR
NORTH LITTLE ROCK AR
72116-7086
US

V. Phone/Fax

Practice location:
  • Phone: 501-748-3456
  • Fax:
Mailing address:
  • Phone: 501-748-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6949-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: