Provider Demographics
NPI:1346829116
Name:ALSTON CLINICAL PRIVATE PRACTICE PLLC
Entity Type:Organization
Organization Name:ALSTON CLINICAL PRIVATE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-836-2278
Mailing Address - Street 1:17 WYNCAIRNE
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9642
Mailing Address - Country:US
Mailing Address - Phone:860-836-2278
Mailing Address - Fax:
Practice Address - Street 1:28 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9769
Practice Address - Country:US
Practice Address - Phone:860-836-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty