Provider Demographics
NPI:1801510995
Name:HAIRSTON, SAPHRONIA IRENE (LCSWA)
Entity type:Individual
Prefix:
First Name:SAPHRONIA
Middle Name:IRENE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 GARRETT GRIGG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-7722
Mailing Address - Country:US
Mailing Address - Phone:251-643-4708
Mailing Address - Fax:
Practice Address - Street 1:10355 GARRETT GRIGG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7722
Practice Address - Country:US
Practice Address - Phone:251-643-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000000Medicaid