Healthcare Provider Details

I. General information

NPI: 1275498255
Provider Name (Legal Business Name): DESTINEE J ALSTON CPSS, CCHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DIVISION AVE NE
WASHINGTON DC
20019-5457
US

IV. Provider business mailing address

5012 SILVER HILL RD
SUITLAND MD
20746-5212
US

V. Phone/Fax

Practice location:
  • Phone: 646-673-1977
  • Fax:
Mailing address:
  • Phone: 646-673-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: