Provider Demographics
NPI:1700335965
Name:HAMILTON-DORELIEN, CHRYSTAL D (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:D
Last Name:HAMILTON-DORELIEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MONTROSE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5800
Mailing Address - Country:US
Mailing Address - Phone:281-236-3989
Mailing Address - Fax:832-202-2479
Practice Address - Street 1:4500 MONTROSE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5800
Practice Address - Country:US
Practice Address - Phone:281-236-3989
Practice Address - Fax:832-202-2479
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62390171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator