Provider Demographics
NPI:1225319544
Name:HAMEL, BLAIR THERESA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:THERESA
Last Name:HAMEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 KAYLA LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2713
Mailing Address - Country:US
Mailing Address - Phone:801-915-5130
Mailing Address - Fax:
Practice Address - Street 1:1914 BRUNSWICK AVE
Practice Address - Street 2:#1B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2808
Practice Address - Country:US
Practice Address - Phone:704-910-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC4841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health