Provider Demographics
NPI:1699370809
Name:HAMPTON, AUTUMN VICTORIA GRACE (MASTERS PSYCHOLOGY)
Entity Type:Individual
Prefix:MISS
First Name:AUTUMN
Middle Name:VICTORIA GRACE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:MASTERS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 CORAL TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-6942
Mailing Address - Country:US
Mailing Address - Phone:606-259-6072
Mailing Address - Fax:
Practice Address - Street 1:648 CORAL TRACE BLVD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-6942
Practice Address - Country:US
Practice Address - Phone:606-259-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program