Provider Demographics
NPI:1164907754
Name:HAMPTON, PATRICK EUGENE (ALC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:EUGENE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:EUGENE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALC
Mailing Address - Street 1:82 COUNTY ROAD 5501
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-5906
Mailing Address - Country:US
Mailing Address - Phone:334-465-5623
Mailing Address - Fax:
Practice Address - Street 1:82 COUNTY ROAD 5501
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-5906
Practice Address - Country:US
Practice Address - Phone:334-465-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2230A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health