Provider Demographics
NPI:1043331143
Name:HAMILTON, GRACE JADE (LPC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:JADE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17558
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-0558
Mailing Address - Country:US
Mailing Address - Phone:503-422-7215
Mailing Address - Fax:
Practice Address - Street 1:15220 NW LAIDLAW RD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7718
Practice Address - Country:US
Practice Address - Phone:503-422-7215
Practice Address - Fax:971-339-8491
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5215101YM0800X
WALH60818621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health