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1801091699
LARRY DEWITT HAIRSTON
LAKE ELSINORE, CA
NPI
1801091699
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106H00000X Marriage & Family Therapist
(Licence: CA MFC25534)
Enumeration Date
2007-06-20
Last Update Date
2014-12-11
Business Address
-- LARRY DEWITT HAIRSTON LMFT
15 PONTE BRAVA
LAKE ELSINORE, CA 92532-0233
Phone number: 951-601-6207
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Mailing Address
-- LARRY DEWITT HAIRSTON LMFT
15 PONTE BRAVA
LAKE ELSINORE, CA 92532-0233
Phone number: 951-601-6207
Copy
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