Provider Demographics
NPI:1669054094
Name:ALSTON, ERICKA CELEEN (CPRS)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:CELEEN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 QUANTRELL AVE APT T7
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2752
Mailing Address - Country:US
Mailing Address - Phone:703-303-9678
Mailing Address - Fax:
Practice Address - Street 1:5851 QUANTRELL AVE APT T7
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2752
Practice Address - Country:US
Practice Address - Phone:703-303-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist