Provider Demographics
NPI:1083715189
Name:HAMILTON, PERSIS MARY (RN, CNS, EDD)
Entity Type:Individual
Prefix:DR
First Name:PERSIS
Middle Name:MARY
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RN, CNS, EDD
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 3535
Mailing Address - Street 2:
Mailing Address - City:YOUNTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94599-3535
Mailing Address - Country:US
Mailing Address - Phone:707-944-2233
Mailing Address - Fax:707-944-9233
Practice Address - Street 1:21 VINEYARD VIEW DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9687
Practice Address - Country:US
Practice Address - Phone:707-944-2233
Practice Address - Fax:707-944-9233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional