=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518454172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALEB DANIEL HAMILTON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2018
-----------------------------------------------------
Last Update Date | 08/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4508 SAINT ANDREWS ROAD STE E PMB51
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-797-3458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4508 SAINT ANDREWS ROAD STE E PMB51
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-797-3458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8577
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------