Provider Demographics
NPI:1568245900
Name:HAMILTON-FAY, ALISON ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ROSE
Last Name:HAMILTON-FAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:HAMILTON-FAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:500 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2535
Mailing Address - Country:US
Mailing Address - Phone:617-529-4018
Mailing Address - Fax:
Practice Address - Street 1:106 STONE AVE
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1538
Practice Address - Country:US
Practice Address - Phone:570-904-7363
Practice Address - Fax:570-348-4079
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional