Provider Demographics
NPI:1285487413
Name:HAMILTON, DUSTIN ISAIAH
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ISAIAH
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8977 COLUMBIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1100
Mailing Address - Country:US
Mailing Address - Phone:513-409-3635
Mailing Address - Fax:513-402-0408
Practice Address - Street 1:8977 COLUMBIA RD STE A
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1100
Practice Address - Country:US
Practice Address - Phone:513-409-3635
Practice Address - Fax:513-402-0408
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X, 101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health