Provider Demographics
NPI:1326008483
Name:HAMILTON, DAVID (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6409
Mailing Address - Country:US
Mailing Address - Phone:616-719-9192
Mailing Address - Fax:
Practice Address - Street 1:550 CASCADE WEST PKWY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2137
Practice Address - Country:US
Practice Address - Phone:616-719-9192
Practice Address - Fax:616-323-3994
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical