Provider Demographics
NPI:1043618994
Name:HOUSTON-HAMILTON, TAMARA (LMSW, LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:HOUSTON-HAMILTON
Suffix:
Gender:F
Credentials:LMSW, LISW-CP
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, LISW-CP
Mailing Address - Street 1:7500 WHITE HORSE ROAD #14183
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610
Mailing Address - Country:US
Mailing Address - Phone:864-416-4560
Mailing Address - Fax:866-204-1733
Practice Address - Street 1:123 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3850
Practice Address - Country:US
Practice Address - Phone:864-416-4560
Practice Address - Fax:866-204-1733
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1043618994OtherBLUE CROSS BLUE SHIELD
SC829755OtherBEACON HEALTH OPTIONS
SCQ51117G199OtherMEDICARE PTAN
SC30258068OtherSELECT HEALTH
SC8450Medicaid