Provider Demographics
NPI:1497587778
Name:BIRSTON, TAKIERA LASHAY
Entity type:Individual
Prefix:
First Name:TAKIERA
Middle Name:LASHAY
Last Name:BIRSTON
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 1:3692 WITTENBURG CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5507
Mailing Address - Country:US
Mailing Address - Phone:404-775-7905
Mailing Address - Fax:
Practice Address - Street 1:3692 WITTENBURG CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5507
Practice Address - Country:US
Practice Address - Phone:404-775-7905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician