Provider Demographics
NPI:1184268260
Name:HAMILTON, JESSICA DENISE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DENISE
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 1:207 WINKLERS CREEK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7838
Mailing Address - Country:US
Mailing Address - Phone:252-751-0518
Mailing Address - Fax:252-565-4505
Practice Address - Street 1:207 WINKLERS CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7838
Practice Address - Country:US
Practice Address - Phone:252-751-0518
Practice Address - Fax:252-565-4505
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-19-37866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst