Healthcare Provider Details

I. General information

NPI: 1083121420
Provider Name (Legal Business Name): KASSANDRA LEE JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA JOHNSON

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W MARKET ST STE 103
AKRON OH
44303-1088
US

IV. Provider business mailing address

2570 8TH STREET
CUYAHOGA FALLS OH
44221
US

V. Phone/Fax

Practice location:
  • Phone: 216-361-9870
  • Fax:
Mailing address:
  • Phone: 330-984-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162035
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404591
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: