Healthcare Provider Details

I. General information

NPI: 1932565876
Provider Name (Legal Business Name): ALTRENEASHA A ERVIN MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALTRENEASHA FORSTON

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22790 SW 112TH AVE
MIAMI FL
33170-7602
US

IV. Provider business mailing address

3849 OAKVEIW DRIVE STE 100
POWDER SPRINGS GA
30127-2207
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-2616
  • Fax: 305-235-6178
Mailing address:
  • Phone: 678-789-9237
  • Fax: 470-878-3139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5303
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001775
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: