Healthcare Provider Details

I. General information

NPI: 1952944290
Provider Name (Legal Business Name): CHABREAH ALSTON LMHC, LCAT, RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date: 10/13/2020
Reactivation Date: 04/20/2021

III. Provider practice location address

12 INMAN ST
CAMBRIDGE MA
02139-2423
US

IV. Provider business mailing address

10117 AVENUE J UNIT 1
BROOKLYN NY
11236-4019
US

V. Phone/Fax

Practice location:
  • Phone: 347-524-1065
  • Fax:
Mailing address:
  • Phone: 347-524-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002590
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12025
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number734
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: