Provider Demographics
NPI:1427450733
Name:HAIRSTON, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HAIRSTON
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 1:625 PINEY FOREST RD STE 305A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2869
Mailing Address - Country:US
Mailing Address - Phone:336-340-3898
Mailing Address - Fax:
Practice Address - Street 1:625 PINEY FOREST RD STE 305A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2869
Practice Address - Country:US
Practice Address - Phone:336-340-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1090-0670589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health