Provider Demographics
NPI:1518195767
Name:HAIRSTON-WHITE, BELYNDA CAMILLE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:BELYNDA
Middle Name:CAMILLE
Last Name:HAIRSTON-WHITE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 BELTON ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1401
Mailing Address - Country:US
Mailing Address - Phone:301-807-7442
Mailing Address - Fax:
Practice Address - Street 1:11031 BELTON ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1401
Practice Address - Country:US
Practice Address - Phone:301-807-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist