Provider Demographics
NPI:1265174031
Name:ALSTON, JAMESHA RENAE (RBT)
Entity type:Individual
Prefix:
First Name:JAMESHA
Middle Name:RENAE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2572 LENOX RD NE APT G2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3126
Mailing Address - Country:US
Mailing Address - Phone:312-874-1853
Mailing Address - Fax:
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD BLDG A1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6769
Practice Address - Country:US
Practice Address - Phone:678-691-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANAOtherNA