Provider Demographics
NPI:1972267268
Name:HAIRSTON, KAYLA EVETTE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:EVETTE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VISTA CIR UNIT C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-1962
Mailing Address - Country:US
Mailing Address - Phone:336-448-9988
Mailing Address - Fax:
Practice Address - Street 1:110 VISTA CIR UNIT C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-1962
Practice Address - Country:US
Practice Address - Phone:336-448-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician