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General NPI Number Information
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NPI Number | 1821460270
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Entity Type | Individual
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Provider Name | JACLYN HAMLIN M.S.C.P, TLLP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 25501 VAN DYKE AVE LIFELINE PSYCHIATRIC SERVICES
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City | CENTER LINE
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State | MI
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Zip | 48015-1208
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Country | US
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Telephone | 586-755-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 31219 ARROWHEAD ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1208
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Country | US
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Telephone | 248-275-9067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016375
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License Number State | MI
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