Provider Demographics
NPI:1144412974
Name:HAMILTON, WENDELL JR (LPCC-S)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:HAMILTON
Suffix:JR
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-8558
Mailing Address - Country:US
Mailing Address - Phone:068-876-3135
Mailing Address - Fax:067-894-8336
Practice Address - Street 1:485 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-8558
Practice Address - Country:US
Practice Address - Phone:606-877-3135
Practice Address - Fax:606-789-4833
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional