Provider Demographics
NPI:1720624794
Name:HAMILTON, CHARLOTTE REDDEN (LPCS,LAC,NCC, ACS)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:REDDEN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPCS,LAC,NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WINDERMERE VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8281
Mailing Address - Country:US
Mailing Address - Phone:803-429-3335
Mailing Address - Fax:
Practice Address - Street 1:5 LAKE CAROLINA WAY STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7562
Practice Address - Country:US
Practice Address - Phone:803-865-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional