Individual
JAMIE RENEE HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LASAC
Contact information
Practice address
3240 HUALAPAI MOUNTAIN RD, KINGMAN, AZ 86401-5306
(928) 753-2665
Mailing address
3609 N ARIZONA ST, KINGMAN, AZ 86409-0749
(520) 561-7078
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15285
AZ
Other
Enumeration date
11/15/2020
Last updated
11/15/2020
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