Provider Demographics
NPI:1205473477
Name:DESKINS, ALVIN RUSSELL (MA, LCPC)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:RUSSELL
Last Name:DESKINS
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 JOEL LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4723
Mailing Address - Country:US
Mailing Address - Phone:240-997-6576
Mailing Address - Fax:
Practice Address - Street 1:4400 STAMP RD STE 403
Practice Address - Street 2:
Practice Address - City:MARLOW HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748-6730
Practice Address - Country:US
Practice Address - Phone:240-470-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty