Provider Demographics
NPI:1811318595
Name:ALSTON, TERRELL N (CSW)
Entity type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:N
Last Name:ALSTON
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 SALEM AVE 2B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208
Mailing Address - Country:US
Mailing Address - Phone:908-289-2970
Mailing Address - Fax:
Practice Address - Street 1:644 SALEM AVE 2B
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208
Practice Address - Country:US
Practice Address - Phone:908-289-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW05209400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker