Provider Demographics
NPI:1417498593
Name:ALSTON, CHASIDY SHANTELLA (LCSWA)
Entity Type:Individual
Prefix:
First Name:CHASIDY
Middle Name:SHANTELLA
Last Name:ALSTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5283 HILLTOP RD
Mailing Address - Street 2:APT P
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5290
Mailing Address - Country:US
Mailing Address - Phone:336-516-5758
Mailing Address - Fax:
Practice Address - Street 1:5283 HILLTOP RD
Practice Address - Street 2:APT P
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5290
Practice Address - Country:US
Practice Address - Phone:336-516-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0112761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical