Provider Demographics
NPI:1417193749
Name:HAMILTON, LAURA A (CHEMICAL DEPENDENCY)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CHEMICAL DEPENDENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:TOKELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98590-0500
Mailing Address - Country:US
Mailing Address - Phone:360-267-2508
Mailing Address - Fax:360-267-6217
Practice Address - Street 1:2373 OLD TOKELAND ROAD
Practice Address - Street 2:BLDG E
Practice Address - City:TOKELAND
Practice Address - State:WA
Practice Address - Zip Code:98590
Practice Address - Country:US
Practice Address - Phone:360-267-8126
Practice Address - Fax:360-267-6217
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 00034789101Y00000X
WACP 00004511101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992817Medicaid