Provider Demographics
NPI:1235331364
Name:ELSTON, DEMITA (BS)
Entity Type:Individual
Prefix:
First Name:DEMITA
Middle Name:
Last Name:ELSTON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:BYNUM
Mailing Address - State:AL
Mailing Address - Zip Code:36253-0762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 NOBLE ST STE 120
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4660
Practice Address - Country:US
Practice Address - Phone:256-741-6160
Practice Address - Fax:256-741-6180
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor