Provider Demographics
NPI:1588173819
Name:ALSTON, TAMIRA
Entity type:Individual
Prefix:
First Name:TAMIRA
Middle Name:
Last Name:ALSTON
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 1:160 CYPRESS POINT PKWY STE B302
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8443
Mailing Address - Country:US
Mailing Address - Phone:386-319-9483
Mailing Address - Fax:
Practice Address - Street 1:160 CYPRESS POINT PKWY STE B302
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8443
Practice Address - Country:US
Practice Address - Phone:386-319-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health