Provider Demographics
NPI:1053546291
Name:JOHNSTON, STEPHANIE A (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5061
Mailing Address - Country:US
Mailing Address - Phone:501-902-5250
Mailing Address - Fax:
Practice Address - Street 1:1304 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5061
Practice Address - Country:US
Practice Address - Phone:501-902-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4085-C1041C0700X
AR2463-M1041C0700X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator