Provider Demographics
NPI:1033835806
Name:HAMILTON, DEANA STACKHOUSE (LPC, CPCS, MAMFT)
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:STACKHOUSE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPC, CPCS, MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 WILLARD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2368
Mailing Address - Country:US
Mailing Address - Phone:716-361-8340
Mailing Address - Fax:
Practice Address - Street 1:1566 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5045
Practice Address - Country:US
Practice Address - Phone:678-701-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
GALPC007545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist