Provider Demographics
NPI:1053933044
Name:JOHNSTON, RHONDA J (CDP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731845
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0020
Mailing Address - Country:US
Mailing Address - Phone:253-770-4720
Mailing Address - Fax:253-770-4721
Practice Address - Street 1:13921 MERIDIAN E STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5605
Practice Address - Country:US
Practice Address - Phone:253-770-4720
Practice Address - Fax:253-770-4721
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60831088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)