Provider Demographics
NPI:1730931361
Name:HAMPTON, LYQAELA UNIQUE
Entity type:Individual
Prefix:
First Name:LYQAELA
Middle Name:UNIQUE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 RARIG AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5736
Mailing Address - Country:US
Mailing Address - Phone:614-317-5833
Mailing Address - Fax:
Practice Address - Street 1:918 RARIG AVE APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-5736
Practice Address - Country:US
Practice Address - Phone:614-317-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172A00000XOther Service ProvidersDriver