Provider Demographics
NPI:1811741556
Name:RALSTON, DANIELLE MARIE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHINABERRY LN
Mailing Address - Street 2:
Mailing Address - City:MAYLENE
Mailing Address - State:AL
Mailing Address - Zip Code:35114-5848
Mailing Address - Country:US
Mailing Address - Phone:585-730-9329
Mailing Address - Fax:
Practice Address - Street 1:113 CHINABERRY LN
Practice Address - Street 2:
Practice Address - City:MAYLENE
Practice Address - State:AL
Practice Address - Zip Code:35114-5848
Practice Address - Country:US
Practice Address - Phone:585-730-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty