Provider Demographics
NPI:1033787205
Name:TOSTON, MALIEKA D (LADC)
Entity Type:Individual
Prefix:
First Name:MALIEKA
Middle Name:D
Last Name:TOSTON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RAPTORS VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6820
Mailing Address - Country:US
Mailing Address - Phone:702-910-6912
Mailing Address - Fax:
Practice Address - Street 1:2000 S EASTERN AVE STE N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4100
Practice Address - Country:US
Practice Address - Phone:702-714-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC15266101YM0800X
NV06739-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1033787205Medicaid