Provider Demographics
NPI:1508369398
Name:HAMILTON, LISA (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 D ST UNIT 151477
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-5718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2622
Practice Address - Country:US
Practice Address - Phone:415-420-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10947101YP2500X
CALPCC4894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-10947OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
CALPCC4894OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES