Provider Demographics
NPI:1093174922
Name:HAMILTON, DALTON
Entity Type:Individual
Prefix:MR
First Name:DALTON
Middle Name:
Last Name:HAMILTON
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 1:375 CONESTOGA WAY UNIT 2512
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-1100
Mailing Address - Country:US
Mailing Address - Phone:914-334-1836
Mailing Address - Fax:
Practice Address - Street 1:375 CONESTOGA WAY UNIT 2512
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-1100
Practice Address - Country:US
Practice Address - Phone:914-334-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health