Healthcare Provider Details

I. General information

NPI: 1629844337
Provider Name (Legal Business Name): JOIA HAIRSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 MANNINGTON RD
ACCOKEEK MD
20607-3479
US

IV. Provider business mailing address

17350 STATE HIGHWAY 249 STE 220
HOUSTON TX
77064-1132
US

V. Phone/Fax

Practice location:
  • Phone: 682-704-0233
  • Fax:
Mailing address:
  • Phone: 682-704-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: