MEDICARE: TIKIHA SHONYETTE ALSTON LPCA, CRC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A10161	NC

General Provider Information

NPI Number	:	1467866368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIKIHA SHONYETTE ALSTON LPCA, CRC

Provider Business Mailing Address
First Line	:	2042 WATERSTONE LN
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-2614
Country	:	US
Telephone Number	:	252-532-9374
Fax Number	:	336-748-3161

Provider Business Practice Location Address
First Line	:	2042 WATERSTONE LN
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-2614
Country	:	US
Telephone Number	:	252-532-9374
Fax Number	:	336-748-3161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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