Individual
DR. LISA RENEE HASTON-FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239
(313) 450-4500
(313) 450-4514
Mailing address
PO BOX 401259, REDFORD, MI 48240-9259
(248) 557-4999
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5101011198
MI
Other
Enumeration date
09/21/2006
Last updated
03/07/2023
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