Provider Demographics
NPI:1902647746
Name:ALSTON, GARY MICHAEL
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:MICHAEL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1613 OWEN DR STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-491-8934
Mailing Address - Fax:910-491-7119
Practice Address - Street 1:1613 OWEN DR STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-491-8934
Practice Address - Fax:910-491-7119
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374U00000X
NCP0227391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374U00000XNursing Service Related ProvidersHome Health Aide