MEDICARE: ALYSSIA SYMONE ALSTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904014232	VA

General Provider Information

NPI Number	:	1659091080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSIA SYMONE ALSTON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	HIGHLAND SPRINGS
State	:	VA
Zip	:	23075-0037
Country	:	US
Telephone Number	:	804-837-9745
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 LENTEN ROSE LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5862
Country	:	US
Telephone Number	:	804-837-9745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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