Lisa Wagoner Hairston, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

10908 Issued in NC

Practice address

2255 Lewisville Clemmons Rd Ste E
Clemmons, NC 27012-7460

Phone

(336) 766-0505

NPI assigned

Jul 21, 2014

Last updated

Oct 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Piedmont Psychiatric Associates PA

  • Mental Health Counselor
  • Clemmons, NC
  • NPI 1750468328
  NPD
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  • Early Intervention Provider Agency
  • Winston Salem, NC
  • NPI 1922277417
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1821405952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 LEWISVILLE CLEMMONS RD STE E",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127460",
            "telephone_number": "336-766-0505",
            "fax_number": "336-766-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 LEWISVILLE CLEMMONS RD STE E",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127460",
            "telephone_number": "336-766-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIRSTON",
        "first_name": "LISA",
        "middle_name": "WAGONER",
        "credential": "LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-21",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "10908",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "10908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisawagoner@lisawagonercounseling.net",
            "affiliation": "N",
            "address_1": "2255 Lewisville Clemmons Rd Ste E",
            "city": "Clemmons",
            "state": "NC",
            "country_code": "US",
            "postal_code": "270127460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James G Guerrini, MD
• Beth Gurley, PA-C
• Joshua Gutierrez, LCMHC-A, LCAS-A
• Susan Abigail Farmer Haas, M.D.
• Richard Edwin Haigler, MD
• Cortez Arnold Hall, RN,BSN
• Courtney Renee Hall, FNP
• Sarah Ellen Hallett, PA-C
• Halo Home Care a Guardian Presence at Home LLC
• Virginia Roehm Hamilton, PA

• Professional Counselor in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.