Provider Demographics
NPI:1407063191
Name:HAIRSTON, DON E (LCSW)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:E
Last Name:HAIRSTON
Suffix:
Gender:M
Credentials:LCSW
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 501
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34755-0501
Mailing Address - Country:US
Mailing Address - Phone:407-461-5312
Mailing Address - Fax:
Practice Address - Street 1:500 W GORDON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4426
Practice Address - Country:US
Practice Address - Phone:407-461-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASSW0025611041C0700X
FLSW64961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical