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General NPI Number Information
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NPI Number | 1205349479
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Entity Type | Organization
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Legal Business Name | DOJUANA HAIRSTON, A MARRIAGE FAMILY THERAPY CORP
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 11/10/2017
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Provider Practice Location Address
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Address Line | 24640 JEFFERSON AVE STE 202
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City | MURRIETA
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State | CA
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Zip | 92562-9027
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Country | US
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Telephone | 951-219-9890
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2532
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City | TEMECULA
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State | CA
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Zip | 92593-2532
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Country | US
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Telephone | 949-929-5535
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Fax |
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Authorized Official
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Title or Position | CEO CLINICAL THERAPIST
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Name | DR. DOJUANA DOLORES HAIRSTON
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Credential | PSYD, LMFT
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Telephone | 949-929-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC41015
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License Number State | CA
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