Individual
MARCELLA HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 SAUNDERS AVE, BECKLEY, WV 25801-6239
(304) 255-1397
Mailing address
1614 S KANAWHA ST, BECKLEY, WV 25801-6239
(304) 255-1397
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083826038
—
WV
05
—
1619185147
—
WV
Enumeration date
12/21/2022
Last updated
05/11/2023
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