Provider Demographics
NPI:1932428398
Name:ALSTON, TRACY (LPC)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BRAWLEY SCHOOL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6869
Mailing Address - Country:US
Mailing Address - Phone:919-606-2566
Mailing Address - Fax:
Practice Address - Street 1:816 BRAWLEY SCHOOL RD
Practice Address - Street 2:SUITE D
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6869
Practice Address - Country:US
Practice Address - Phone:919-606-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104562Medicaid