1699841825 NPI number — MRS. GRACE GRINDLE JOHNSTON LCSW, LCAS

Table of content: MRS. GRACE GRINDLE JOHNSTON LCSW, LCAS (NPI 1699841825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699841825 NPI number — MRS. GRACE GRINDLE JOHNSTON LCSW, LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
GRACE
Provider Middle Name:
GRINDLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699841825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 MARY LEE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28590-9917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-814-9191
Provider Business Mailing Address Fax Number:
252-355-7947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 CROMWELL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27858-5894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-814-9191
Provider Business Practice Location Address Fax Number:
252-355-7947
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C005291 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 1077 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143K1 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6106386 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190827 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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