Healthcare Provider Details

I. General information

NPI: 1831055912
Provider Name (Legal Business Name): JENNIFER JOHNSTON MA, LCMHC-A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 PORTOFINO PL
DAVIDSON NC
28036-6959
US

IV. Provider business mailing address

1226 PORTOFINO PL
DAVIDSON NC
28036-6959
US

V. Phone/Fax

Practice location:
  • Phone: 248-505-2854
  • Fax:
Mailing address:
  • Phone: 248-505-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22365
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: