Healthcare Provider Details

I. General information

NPI: 1568394021
Provider Name (Legal Business Name): RALSTON COLLECTIVE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CHINABERRY LN
MAYLENE AL
35114-5848
US

IV. Provider business mailing address

113 CHINABERRY LN
MAYLENE AL
35114-5848
US

V. Phone/Fax

Practice location:
  • Phone: 585-730-9329
  • Fax:
Mailing address:
  • Phone: 585-730-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MARIE RALSTON
Title or Position: CEO
Credential: ADHD-CCSP
Phone: 585-730-9329