Healthcare Provider Details

I. General information

NPI: 1114593829
Provider Name (Legal Business Name): LATOYA HAIRSTON QASP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 SANDHURST DR
FAYETTEVILLE NC
28304-4426
US

IV. Provider business mailing address

5215 SPRUCE DR
FAYETTEVILLE NC
28304-2324
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-9020
  • Fax:
Mailing address:
  • Phone: 910-223-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberA4570
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: