Provider Demographics
NPI:1013369933
Name:HAMINGSON, ZACHARY M (MA LCPC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:M
Last Name:HAMINGSON
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:MR
Other - First Name:ZACK
Other - Middle Name:
Other - Last Name:HAMINGSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LCPC
Mailing Address - Street 1:3322 N ASHLAND AVE
Mailing Address - Street 2:BSMT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0195
Mailing Address - Country:US
Mailing Address - Phone:815-751-1268
Mailing Address - Fax:
Practice Address - Street 1:3322 N ASHLAND AVE
Practice Address - Street 2:BSMT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0195
Practice Address - Country:US
Practice Address - Phone:815-751-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional