Provider Demographics
NPI:1497217525
Name:HAIRSTON, LAUREN JALISA
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:JALISA
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 PROSPECT AVE STE 323
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4377
Mailing Address - Country:US
Mailing Address - Phone:216-273-7233
Mailing Address - Fax:
Practice Address - Street 1:4614 PROSPECT AVE STE 323
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4377
Practice Address - Country:US
Practice Address - Phone:216-273-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator