Provider Demographics
NPI:1760072953
Name:HAIRSTON, MARGUERITE Z (LPC)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:Z
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 MUSTANG RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7443
Mailing Address - Country:US
Mailing Address - Phone:832-423-0410
Mailing Address - Fax:
Practice Address - Street 1:11601 SHADOW CREEK PKWY STE 111-163
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7284
Practice Address - Country:US
Practice Address - Phone:832-423-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional