Provider Demographics
NPI:1487896221
Name:JOHNSTON, KELLY L (MS, BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1629 COLUMBIA RD NW
Practice Address - Street 2:#608
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3662
Practice Address - Country:US
Practice Address - Phone:215-888-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst