Provider Demographics
NPI:1669022984
Name:HAMILTON, JOHNNIYA
Entity Type:Individual
Prefix:
First Name:JOHNNIYA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 N STATE ROAD 7 STE B1
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5870
Mailing Address - Country:US
Mailing Address - Phone:786-352-9494
Mailing Address - Fax:
Practice Address - Street 1:4699 N STATE ROAD 7 STE B1
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5870
Practice Address - Country:US
Practice Address - Phone:786-352-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3165106H00000X
FLIMT3165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist