Healthcare Provider Details

I. General information

NPI: 1578836508
Provider Name (Legal Business Name): LORI HAMLIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI LONDON

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOWSON AVE
FORT SMITH AR
72901-2632
US

IV. Provider business mailing address

100 TOWSON AVE
FORT SMITH AR
72901-2632
US

V. Phone/Fax

Practice location:
  • Phone: 479-784-9801
  • Fax: 479-784-9805
Mailing address:
  • Phone: 479-784-9801
  • Fax: 479-784-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0812101
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: