Provider Demographics
NPI:1265831499
Name:RALSTON, ERIC (LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RALSTON
Suffix:
Gender:M
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8213 IGOU GAP RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2708
Mailing Address - Country:US
Mailing Address - Phone:423-762-3146
Mailing Address - Fax:
Practice Address - Street 1:8213 IGOU GAP RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2708
Practice Address - Country:US
Practice Address - Phone:423-762-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional