Provider Demographics
NPI:1972165157
Name:HAIRSTON & ASSOCIATES THERAPEUTIC AND COMMUNITY TREATMENT SERVICES
Entity Type:Organization
Organization Name:HAIRSTON & ASSOCIATES THERAPEUTIC AND COMMUNITY TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-221-8351
Mailing Address - Street 1:16170 BUCKFAST PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015-1571
Mailing Address - Country:US
Mailing Address - Phone:804-221-8351
Mailing Address - Fax:
Practice Address - Street 1:1905 HUGUENOT RD STE 308
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4312
Practice Address - Country:US
Practice Address - Phone:804-221-8351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health