Provider Demographics
NPI:1679276901
Name:HAMRICK, SALLY ANN
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:HAMRICK
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 1:916 CLUBVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5972
Mailing Address - Country:US
Mailing Address - Phone:864-490-3911
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 8C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5990
Practice Address - Country:US
Practice Address - Phone:725-444-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2019-055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst