Provider Demographics
NPI:1619413812
Name:HAIRSTON, PORTIA (LCSW)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 HUGUENOT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4312
Mailing Address - Country:US
Mailing Address - Phone:540-259-1726
Mailing Address - Fax:
Practice Address - Street 1:16170 BUCKFAST PL
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-1571
Practice Address - Country:US
Practice Address - Phone:540-259-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical