Provider Demographics
NPI:1790926020
Name:JANICE B. HAIRSTON, LCSW, LLC
Entity Type:Organization
Organization Name:JANICE B. HAIRSTON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-233-3300
Mailing Address - Street 1:5819 S MELBECK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5279
Mailing Address - Country:US
Mailing Address - Phone:804-233-3300
Mailing Address - Fax:804-275-0480
Practice Address - Street 1:400 TURNER RD
Practice Address - Street 2:STE 5
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-6420
Practice Address - Country:US
Practice Address - Phone:804-233-3300
Practice Address - Fax:804-275-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001447Medicare PIN