Provider Demographics
NPI:1659501849
Name:HAMILTON-WOOTEN, SASHA M
Entity type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:M
Last Name:HAMILTON-WOOTEN
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 1:13010 NE 28TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6437
Mailing Address - Country:US
Mailing Address - Phone:360-605-2386
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 28TH WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6437
Practice Address - Country:US
Practice Address - Phone:360-605-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61509295101YM0800X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty