Individual
LISA WAGONER HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
2255 LEWISVILLE CLEMMONS RD STE E, CLEMMONS, NC 27012-7460
(336) 766-0505
Mailing address
2255 LEWISVILLE CLEMMONS RD STE E, CLEMMONS, NC 27012-7460
(336) 766-0505
(336) 766-0505
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10908
NC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
10908
NC
Other
Enumeration date
07/21/2014
Last updated
10/26/2021
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