Provider Demographics
NPI:1780206623
Name:HAIRSTON, LEAH (MSSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 GUILFORD AVE # 740
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3707
Mailing Address - Country:US
Mailing Address - Phone:410-929-0411
Mailing Address - Fax:
Practice Address - Street 1:822 GUILFORD AVE # 740
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3707
Practice Address - Country:US
Practice Address - Phone:410-929-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No104100000XBehavioral Health & Social Service ProvidersSocial Worker