Provider Demographics
NPI:1669027934
Name:HAMILTON, ELISHA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELISHA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 S STATE ROUTE 45 52
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-6047
Mailing Address - Country:US
Mailing Address - Phone:815-690-5587
Mailing Address - Fax:
Practice Address - Street 1:70 KEN HAYES DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9379
Practice Address - Country:US
Practice Address - Phone:815-690-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional