Provider Demographics
NPI:1215543194
Name:HAMILTON, KIMBERLY C (MA, LMHC, SUDP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MA, LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 SUNNYSIDE AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6956
Mailing Address - Country:US
Mailing Address - Phone:206-395-6144
Mailing Address - Fax:
Practice Address - Street 1:4649 SUNNYSIDE AVE N STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6956
Practice Address - Country:US
Practice Address - Phone:206-395-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60888753103TA0400X
WALH61094473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)