Provider Demographics
NPI:1831604305
Name:HAMM, MACY MELISSA (LCAS)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:MELISSA
Last Name:HAMM
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 SILVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9359
Mailing Address - Country:US
Mailing Address - Phone:919-656-1633
Mailing Address - Fax:919-706-5158
Practice Address - Street 1:806 BELL FORK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6312
Practice Address - Country:US
Practice Address - Phone:910-347-2205
Practice Address - Fax:910-347-2216
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23391101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)