Provider Demographics
NPI:1023594108
Name:ALSTON, WALLACE LAMONE
Entity type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:LAMONE
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 SILVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3469
Mailing Address - Country:US
Mailing Address - Phone:704-534-7658
Mailing Address - Fax:980-938-4354
Practice Address - Street 1:9517 SILVERDALE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3469
Practice Address - Country:US
Practice Address - Phone:704-534-7658
Practice Address - Fax:980-938-4354
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)