Provider Demographics
NPI:1033283742
Name:ALSTON-JOHNSON, CYNTHIA REBECCA (MSW,ACSW,LMSW,CEAP,B)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:REBECCA
Last Name:ALSTON-JOHNSON
Suffix:
Gender:F
Credentials:MSW,ACSW,LMSW,CEAP,B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MONARCH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8115
Mailing Address - Country:US
Mailing Address - Phone:803-865-8591
Mailing Address - Fax:
Practice Address - Street 1:90 BRIGHTON HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7987
Practice Address - Country:US
Practice Address - Phone:803-741-1271
Practice Address - Fax:803-741-7429
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006733101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC006733OtherLMSW