Provider Demographics
NPI:1508882119
Name:HAMPTON-AYTCH, DYAN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:DYAN
Middle Name:
Last Name:HAMPTON-AYTCH
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25583 LINDENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-6191
Mailing Address - Country:US
Mailing Address - Phone:248-352-3474
Mailing Address - Fax:
Practice Address - Street 1:25583 LINDENWOOD LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6191
Practice Address - Country:US
Practice Address - Phone:248-352-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical