Healthcare Provider Details

I. General information

NPI: 1083342174
Provider Name (Legal Business Name): COURTNEY ALSTON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

330 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

V. Phone/Fax

Practice location:
  • Phone: 786-838-5535
  • Fax:
Mailing address:
  • Phone: 386-676-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: