Provider Demographics
NPI:1093810640
Name:HAIRSTON, DOJUANA DOLORES (PSYD LMFT)
Entity Type:Individual
Prefix:DR
First Name:DOJUANA
Middle Name:DOLORES
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:PSYD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-2532
Mailing Address - Country:US
Mailing Address - Phone:949-929-5535
Mailing Address - Fax:951-263-5283
Practice Address - Street 1:24640 JEFFERSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9027
Practice Address - Country:US
Practice Address - Phone:951-219-9890
Practice Address - Fax:951-263-5283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41015106H00000X
CAMFC 41015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist