Provider Demographics
NPI:1467281386
Name:ALSTON BRIGHT START MENTAL HEALTH
Entity type:Organization
Organization Name:ALSTON BRIGHT START MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HABILITATION TECH
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-438-5738
Mailing Address - Street 1:5504 HERALDY CT
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7692
Mailing Address - Country:US
Mailing Address - Phone:919-438-5738
Mailing Address - Fax:
Practice Address - Street 1:134 PARKTOWN RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-9153
Practice Address - Country:US
Practice Address - Phone:919-438-5738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265299259OtherNPI