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General NPI Number Information
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NPI Number | 1790926020
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Entity Type | Organization
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Legal Business Name | JANICE B. HAIRSTON, LCSW, LLC
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 400 TURNER RD STE 5
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City | RICHMOND
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State | VA
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Zip | 23225-6420
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Country | US
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Telephone | 804-233-3300
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Fax | 804-275-0480
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Provider Business Mailing Address
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Address Line | 5819 S MELBECK RD
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City | RICHMOND
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State | VA
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Zip | 23234-5279
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Country | US
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Telephone | 804-233-3300
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Fax | 804-275-0480
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. JANICE BERNADETTE HAIRSTON
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Credential | LCSW
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Telephone | 804-233-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006223
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License Number State | VA
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