Provider Demographics
NPI:1417247768
Name:HAMILTON, ADAM GORDON (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GORDON
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 ASPEN DR APT 4203
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2323
Mailing Address - Country:US
Mailing Address - Phone:248-568-5180
Mailing Address - Fax:
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:STE. 270
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-731-4100
Practice Address - Fax:586-731-4063
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health