Provider Demographics
NPI:1619866977
Name:ALSTON, SHAUNEEQUA DEVONEE
Entity type:Individual
Prefix:MS
First Name:SHAUNEEQUA
Middle Name:DEVONEE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:DEVONEE
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11138 DEL AMO BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1103
Mailing Address - Country:US
Mailing Address - Phone:202-425-6696
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2180
Practice Address - Country:US
Practice Address - Phone:800-726-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health