Provider Demographics
NPI:1659656106
Name:HAMILTON, RICHARD (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 LOST CABIN PL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8648
Mailing Address - Country:US
Mailing Address - Phone:770-873-9400
Mailing Address - Fax:
Practice Address - Street 1:3055 LOST CABIN PL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8648
Practice Address - Country:US
Practice Address - Phone:770-873-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional