Provider Demographics
NPI:1750569612
Name:ALSTON, DANA JEAN (MA LP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JEAN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:JEAN
Other - Last Name:HAWKSFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:651-338-6015
Mailing Address - Fax:651-241-2211
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:651-338-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health