Provider Demographics
NPI:1184911679
Name:HAMRICK, MARIE ALICE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ALICE
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12279 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4450
Mailing Address - Country:US
Mailing Address - Phone:909-553-9484
Mailing Address - Fax:
Practice Address - Street 1:12279 CUSTER ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4450
Practice Address - Country:US
Practice Address - Phone:909-553-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127343106H00000X
174H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174H00000XOther Service ProvidersHealth Educator