Provider Demographics
NPI:1578836508
Name:HAMLIN, LORI (LAC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-2632
Mailing Address - Country:US
Mailing Address - Phone:479-784-9801
Mailing Address - Fax:479-784-9805
Practice Address - Street 1:100 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-2632
Practice Address - Country:US
Practice Address - Phone:479-784-9801
Practice Address - Fax:479-784-9805
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0812101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health