Provider Demographics
NPI:1235896754
Name:HAMILTON, LAVONNA CLEOPATRA
Entity Type:Individual
Prefix:
First Name:LAVONNA
Middle Name:CLEOPATRA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RED
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3741 SE 127TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3296
Mailing Address - Country:US
Mailing Address - Phone:503-512-0450
Mailing Address - Fax:
Practice Address - Street 1:3741 SE 127TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3296
Practice Address - Country:US
Practice Address - Phone:503-960-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor