MEDICARE: MRS. DEANA STACKHOUSE HAMILTON LPC, CPCS, MAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist
3	101YP2500X	Professional Counselor	LPC007545	GA

General Provider Information

NPI Number	:	1033835806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEANA STACKHOUSE HAMILTON LPC, CPCS, MAMFT

Provider Business Mailing Address
First Line	:	642 WILLARD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2368
Country	:	US
Telephone Number	:	716-361-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1566 DONALD LEE HOLLOWELL PKWY NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5045
Country	:	US
Telephone Number	:	678-701-8584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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