Provider Demographics
NPI:1215384508
Name:HAMILTON, CLIFFORD (LPC)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 GA HIGHWAY 130 W
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5567
Mailing Address - Country:US
Mailing Address - Phone:478-290-8710
Mailing Address - Fax:912-805-5241
Practice Address - Street 1:2270 GA HIGHWAY 130 W
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5567
Practice Address - Country:US
Practice Address - Phone:478-290-8710
Practice Address - Fax:912-805-5241
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional