Provider Demographics
NPI:1720258858
Name:HAIRSTON, DALISHA A (LPC)
Entity Type:Individual
Prefix:MS
First Name:DALISHA
Middle Name:A
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:A
Other - Last Name:HAIRSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4001 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3405
Mailing Address - Country:US
Mailing Address - Phone:214-676-0798
Mailing Address - Fax:
Practice Address - Street 1:4001 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3405
Practice Address - Country:US
Practice Address - Phone:214-676-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional