Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1866 | NC |
Y | 103T00000X | Psychologist | 1866 | NC |
NPI | 1013985712 |
---|---|
Provider Name | Edward Richards Johnston III |
First Address | Asheville, NC 28803-8570 |
Second Address | Asheville, NC 28803-8570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
? | TRICARE (01) | NC |
0454A | BCBS OF NC (01) | NC |
6107299 | (05) | NC |
N/A | CBHA (01) | NC |