Healthcare Provider Details

I. General information

NPI: 1376178517
Provider Name (Legal Business Name): ALSTON COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 LAKE PLAZA DR STE 100
COLORADO SPRINGS CO
80906-3541
US

IV. Provider business mailing address

1255 LAKE PLAZA DR STE 100
COLORADO SPRINGS CO
80906-3541
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-2768
  • Fax: 719-434-2768
Mailing address:
  • Phone: 719-434-2768
  • Fax: 719-434-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: VENESSA ELLINGTON ALSTON
Title or Position: OWNER
Credential: LAC, LCSW
Phone: 719-434-2768