Healthcare Provider Details

I. General information

NPI: 1861339962
Provider Name (Legal Business Name): DEFI TRAUMA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 LADYS SECRET DR
INDIAN TRAIL NC
28079-5716
US

IV. Provider business mailing address

6720 OLD MONROE RD STE B
INDIAN TRAIL NC
28079-5353
US

V. Phone/Fax

Practice location:
  • Phone: 704-273-9166
  • Fax:
Mailing address:
  • Phone: 704-273-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CLAUDINE ALICIA HAMILTON
Title or Position: OWNER
Credential: LCMHC
Phone: 980-347-8488