Provider Demographics
NPI:1518473685
Name:WADE-HAIRSTON, TINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:WADE-HAIRSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8072 NEW ALBANY CONDIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9535
Mailing Address - Country:US
Mailing Address - Phone:614-557-1145
Mailing Address - Fax:
Practice Address - Street 1:2525 TILLER LN STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2267
Practice Address - Country:US
Practice Address - Phone:614-557-1145
Practice Address - Fax:614-557-1145
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health