Provider Demographics
NPI:1265121792
Name:WINSTON, ALONZO
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:
Last Name:WINSTON
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 1:1613 S CHURCH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1831
Mailing Address - Country:US
Mailing Address - Phone:757-279-0700
Mailing Address - Fax:757-279-0282
Practice Address - Street 1:1613 S CHURCH ST STE 7
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1831
Practice Address - Country:US
Practice Address - Phone:757-279-0700
Practice Address - Fax:757-279-0282
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services