Provider Demographics
NPI:1326586751
Name:HAMRICK, DOMINIQUE S
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:S
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BW THOMAS DR STE 111112
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7230
Mailing Address - Country:US
Mailing Address - Phone:980-237-8007
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR STE 111112
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7230
Practice Address - Country:US
Practice Address - Phone:980-237-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator