Provider Demographics
NPI:1942548490
Name:ALSTON, EVANGELINE
Entity Type:Individual
Prefix:MS
First Name:EVANGELINE
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 HALIBUT PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4819 ISENHOWER AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:23304
Practice Address - Country:US
Practice Address - Phone:301-765-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)