Provider Demographics
NPI:1164179925
Name:ALSTON, ALEISHA DENISE
Entity Type:Individual
Prefix:
First Name:ALEISHA
Middle Name:DENISE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13518 METTETAL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1704
Mailing Address - Country:US
Mailing Address - Phone:313-939-0466
Mailing Address - Fax:
Practice Address - Street 1:13518 METTETAL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1704
Practice Address - Country:US
Practice Address - Phone:313-939-0466
Practice Address - Fax:855-630-9914
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X, 103TS0200X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool