Healthcare Provider Details

I. General information

NPI: 1184987182
Provider Name (Legal Business Name): GEORGE M. HAMILTON,LPC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BEL AIR BLVD STE 10
MOBILE AL
36606-3503
US

IV. Provider business mailing address

605 BEL AIR BLVD STE 10
MOBILE AL
36606-3503
US

V. Phone/Fax

Practice location:
  • Phone: 251-478-5050
  • Fax: 251-478-5015
Mailing address:
  • Phone: 251-478-5050
  • Fax: 251-478-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number628
License Number StateAL

VIII. Authorized Official

Name: MR. GEORGE MCAULEY HAMILTON
Title or Position: SOLE PROPRIETOR
Credential: LPC
Phone: 251-478-5050