Healthcare Provider Details

I. General information

NPI: 1295346898
Provider Name (Legal Business Name): TARRYN T ALSTON LACMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRANDYWINE BLVD
TALLEYVILLE DE
19803-1838
US

IV. Provider business mailing address

19 BRANDYWINE BLVD
TALLEYVILLE DE
19803-1838
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-7779
  • Fax: 302-467-2920
Mailing address:
  • Phone: 302-703-7779
  • Fax: 302-467-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0010434
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: