Provider Demographics
NPI:1629357132
Name:ALSTON, DARCI DENNEY (CMHC)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:DENNEY
Last Name:ALSTON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:
Other - Last Name:DENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2139
Mailing Address - Country:US
Mailing Address - Phone:435-850-7378
Mailing Address - Fax:801-302-7248
Practice Address - Street 1:28 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2139
Practice Address - Country:US
Practice Address - Phone:435-850-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11258764-6004101YM0800X
NY008739-1101YM0800X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1629357132Medicaid