Provider Demographics
NPI:1922344530
Name:ALSTON, MELINDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5813
Mailing Address - Country:US
Mailing Address - Phone:630-205-8294
Mailing Address - Fax:
Practice Address - Street 1:109 S BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5813
Practice Address - Country:US
Practice Address - Phone:630-205-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20827111041S0200X
IL1490052011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool