MEDICARE: MOLLIE JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	11483	NC

General Provider Information

NPI Number	:	1619325495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE JOHNSTON

Provider Business Mailing Address
First Line	:	7615 COLONY RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5017
Country	:	US
Telephone Number	:	704-365-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	7615 COLONY RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5017
Country	:	US
Telephone Number	:	704-365-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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Directions to “ MOLLIE JOHNSTON ” Practice Location

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