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General NPI Number Information
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NPI Number | 1699443242
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Entity Type | Individual
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Provider Name | MARIAH L HAIRSTON
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 3880 CATALINA ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-2211
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Country | US
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Telephone | 321-346-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 SUNNY BROOK LN NE APT A212
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City | PALM BAY
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State | FL
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Zip | 32905-6513
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Country | US
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Telephone | 407-431-7224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-156605
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License Number State | FL
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