Provider Demographics
NPI:1447825104
Name:JOHNSTON, MOLLY (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
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 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:407-588-6294
Practice Address - Street 1:6385 MCGINNIS FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3672
Practice Address - Country:US
Practice Address - Phone:470-508-9575
Practice Address - Fax:470-408-2696
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst