Healthcare Provider Details

I. General information

NPI: 1679299390
Provider Name (Legal Business Name): KIRA HAJA HOSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WELLINGTON DR
MCDONOUGH GA
30252-2902
US

IV. Provider business mailing address

7106 NW 92ND TER
TAMARAC FL
33321-3147
US

V. Phone/Fax

Practice location:
  • Phone: 404-429-1633
  • Fax:
Mailing address:
  • Phone: 770-687-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: