Provider Demographics
NPI:1871326538
Name:HAMILTON, JENA FAITH (CADC-I)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:FAITH
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-9463
Mailing Address - Country:US
Mailing Address - Phone:919-214-1457
Mailing Address - Fax:
Practice Address - Street 1:129 MAYO ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2573
Practice Address - Country:US
Practice Address - Phone:855-567-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-28976171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator