Provider Demographics
NPI:1548028004
Name:HAMILTON, OLIVIA (PCI)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WOODMONT LN NW # 816
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:470-997-0616
Mailing Address - Fax:470-878-2470
Practice Address - Street 1:9106 RETREAT PASS
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-5288
Practice Address - Country:US
Practice Address - Phone:470-997-0616
Practice Address - Fax:470-878-2470
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06012022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor