Provider Demographics
NPI:1760202386
Name:LAIRD, ALBERT DUSTIN
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:DUSTIN
Last Name:LAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 DEER MOSS TRL
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-1343
Mailing Address - Country:US
Mailing Address - Phone:813-786-7976
Mailing Address - Fax:
Practice Address - Street 1:359 DEER MOSS TRL
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-1343
Practice Address - Country:US
Practice Address - Phone:813-786-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service