Provider Demographics
NPI:1114750486
Name:HAIRSTON, CHRISTOPHER TODD
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:HAIRSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 ALLERTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4481
Mailing Address - Country:US
Mailing Address - Phone:410-258-2541
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3331
Practice Address - Country:US
Practice Address - Phone:336-332-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health