Provider Demographics
NPI:1912723651
Name:HAMILTON-THORNTON, DEONDRA LAVON (ALC)
Entity type:Individual
Prefix:
First Name:DEONDRA
Middle Name:LAVON
Last Name:HAMILTON-THORNTON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:DEONDRA
Other - Middle Name:LAVON
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALC
Mailing Address - Street 1:8450 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2203
Mailing Address - Country:US
Mailing Address - Phone:334-322-3382
Mailing Address - Fax:
Practice Address - Street 1:8450 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2203
Practice Address - Country:US
Practice Address - Phone:334-322-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health