Provider Demographics
NPI:1447829486
Name:HAMILTON, SUSAN JANICE (SUDPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANICE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0072
Mailing Address - Country:US
Mailing Address - Phone:360-452-4062
Mailing Address - Fax:360-452-4189
Practice Address - Street 1:3430 E HIGHWAY 101 STE 3
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9069
Practice Address - Country:US
Practice Address - Phone:360-452-4062
Practice Address - Fax:360-452-4189
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61175491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional