Provider Demographics
NPI:1386920213
Name:HAMILTON, MARIE MILLIGAN
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:MILLIGAN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:M
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:15023 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2244
Mailing Address - Country:US
Mailing Address - Phone:313-653-4511
Mailing Address - Fax:
Practice Address - Street 1:15023 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2244
Practice Address - Country:US
Practice Address - Phone:313-653-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010159681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical