Healthcare Provider Details

I. General information

NPI: 1689995680
Provider Name (Legal Business Name): WENDY ANGELINA JOHNSTON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 SUNNY MEADOW LN NE
BOLIVIA NC
28422-7004
US

IV. Provider business mailing address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

V. Phone/Fax

Practice location:
  • Phone: 240-920-8995
  • Fax:
Mailing address:
  • Phone: 866-991-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15890
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: