Provider Demographics
NPI:1164954129
Name:HAMILTON, DEBRA (PSYD, LLP)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PSYD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 COOLEY LAKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3537
Mailing Address - Country:US
Mailing Address - Phone:248-301-5585
Mailing Address - Fax:
Practice Address - Street 1:7805 COOLEY LAKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3537
Practice Address - Country:US
Practice Address - Phone:248-301-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017283103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical