Most Relevant Information
Provider Data
| NPI Number: | 1003300195 |
| Provider Name: | TAWAN BINNETTA ALSTON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/21/2018 |
| Last Updated: | 06/21/2018 |
Provider Practice Location
164 WACCAMAW MEDICAL PARK DR
CONWAY
SC
295268903
Practice Location Phone/Fax
| Phone: | 8433475060 |
| Fax: |
Provider Mailing Location
164 WACCAMAW MEDICAL PARK DR
CONWAY
SC
295268903
Provider Mailing Phone/Fax
| Phone: | 8433475060 |
| Fax: |