Provider Demographics
NPI:1811329659
Name:ALSTON, EMANUEL MANNIE JR (LISW-CP)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:MANNIE
Last Name:ALSTON
Suffix:JR
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 DULAMO RD
Mailing Address - Street 2:
Mailing Address - City:ST HELENA IS
Mailing Address - State:SC
Mailing Address - Zip Code:29920-3309
Mailing Address - Country:US
Mailing Address - Phone:888-446-2214
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG # VILLAGEC
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC166101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical