Provider Demographics
NPI:1205349479
Name:DOJUANA HAIRSTON, A MARRIAGE FAMILY THERAPY CORP
Entity type:Organization
Organization Name:DOJUANA HAIRSTON, A MARRIAGE FAMILY THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOJUANA
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:949-929-5535
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-2532
Mailing Address - Country:US
Mailing Address - Phone:949-929-5535
Mailing Address - Fax:
Practice Address - Street 1:24640 JEFFERSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9027
Practice Address - Country:US
Practice Address - Phone:951-219-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41015251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health