Provider Demographics
NPI:1740775220
Name:ELLINGTON ALSTON, VENESSA (LAC, LCSW)
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:ELLINGTON ALSTON
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LAKE PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3541
Mailing Address - Country:US
Mailing Address - Phone:719-434-2768
Mailing Address - Fax:
Practice Address - Street 1:1255 LAKE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3541
Practice Address - Country:US
Practice Address - Phone:719-434-2768
Practice Address - Fax:719-434-2768
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001046101YA0400X
COCSW.099262741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)