Provider Demographics
NPI:1912384827
Name:PROVIDENCE HUMAN SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE HUMAN SERVICES
Other - Org Name:PROVIDENCE HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-207-3140
Mailing Address - Street 1:4246 AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2515
Mailing Address - Country:US
Mailing Address - Phone:352-277-2152
Mailing Address - Fax:
Practice Address - Street 1:11428B N.53 STREET
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:813-374-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management