Healthcare Provider Details

I. General information

NPI: 1184843757
Provider Name (Legal Business Name): JOHNSTON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N 3RD ST
SMITHFIELD NC
27577-3939
US

IV. Provider business mailing address

PO BOX 1835
SMITHFIELD NC
27577-1835
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-0921
  • Fax: 919-938-3807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number632
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3041
License Number StateNC

VIII. Authorized Official

Name: MR. ANTHONY MARTIN WOODALL
Title or Position: OWNER
Credential: MA, LPC, LCAS
Phone: 919-938-0921