Individual
CARL RALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
722 SCOTT ST, COVINGTON, KY 41011-2418
(859) 491-1361
Mailing address
502 FARRELL DR, COVINGTON, KY 41011-3717
(859) 578-3204
(859) 578-3273
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
—
Enumeration date
01/29/2014
Last updated
01/29/2014
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