Provider Demographics
NPI:1538231691
Name:HAMILTON, CAROL CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CHRISTINE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55970
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97238-5970
Mailing Address - Country:US
Mailing Address - Phone:505-848-8560
Mailing Address - Fax:503-296-2694
Practice Address - Street 1:2613 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3761
Practice Address - Country:US
Practice Address - Phone:505-840-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201004027OtherPHP
NMN0607Medicaid
NN900NK28OtherBCBS