Provider Demographics
NPI:1184094922
Name:HAIRSTON, KRISTIAN A
Entity type:Individual
Prefix:MS
First Name:KRISTIAN
Middle Name:A
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 1:805 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-8310
Mailing Address - Country:US
Mailing Address - Phone:856-649-8704
Mailing Address - Fax:
Practice Address - Street 1:805 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-8310
Practice Address - Country:US
Practice Address - Phone:856-649-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health