Provider Demographics
NPI:1295346898
Name:ALSTON, TARRYN T (LACMH)
Entity type:Individual
Prefix:MRS
First Name:TARRYN
Middle Name:T
Last Name:ALSTON
Suffix:
Gender:F
Credentials:LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLEYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1838
Mailing Address - Country:US
Mailing Address - Phone:302-703-7779
Mailing Address - Fax:302-467-2920
Practice Address - Street 1:19 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:TALLEYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19803-1838
Practice Address - Country:US
Practice Address - Phone:302-703-7779
Practice Address - Fax:302-467-2920
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0010434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health