Provider Demographics
NPI:1952815136
Name:HAIRSTON, CLAUDETTE (LLPC, LMT)
Entity Type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LLPC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 S LINDEN RD STE 20
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5462
Mailing Address - Country:US
Mailing Address - Phone:810-730-1721
Mailing Address - Fax:
Practice Address - Street 1:2503 S LINDEN RD
Practice Address - Street 2:SUITE 20
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5462
Practice Address - Country:US
Practice Address - Phone:810-730-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019597101Y00000X
MI7501004321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor