Provider Demographics
NPI:1194885327
Name:HAMILTON, MARTHA DICKERSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:DICKERSON
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 VIRGINIA BEACH BLVD
Mailing Address - Street 2:#B12
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4419
Mailing Address - Country:US
Mailing Address - Phone:757-486-6515
Mailing Address - Fax:757-498-5452
Practice Address - Street 1:613 NORTH LYNN HAVEN RD
Practice Address - Street 2:STE B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4419
Practice Address - Country:US
Practice Address - Phone:757-486-6515
Practice Address - Fax:757-498-5452
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0016521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005638063OtherAETNA
023220OtherVALUE OPTIONS
VA330004OtherANTHEM BCBS