MEDICARE: MICHELE ROBIN HAIRSTON LCPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A12063	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043675671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ROBIN HAIRSTON LCPA

Provider Business Mailing Address
First Line	:	PO BOX 1083
Second Line	:
City	:	LEWISVILLE
State	:	NC
Zip	:	27023-1083
Country	:	US
Telephone Number	:	336-291-7477
Fax Number	:	336-217-8044

Provider Business Practice Location Address
First Line	:	2430 REYNOLDA RD STE 2B
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4626
Country	:	US
Telephone Number	:	336-291-7477
Fax Number	:	336-217-8044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2015
Last Update Date	:	03/29/2017

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