Provider Demographics
NPI:1194988576
Name:HAIRSTON, ANGELA G (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:G
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BASIN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6376
Mailing Address - Country:US
Mailing Address - Phone:703-781-2457
Mailing Address - Fax:703-799-0189
Practice Address - Street 1:9160 BELVOIR WOODS PKWY
Practice Address - Street 2:
Practice Address - City:FT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-2703
Practice Address - Country:US
Practice Address - Phone:703-781-2457
Practice Address - Fax:703-799-0189
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist