Provider Demographics
NPI:1962148080
Name:HAMILTON, KENYA ANTOINETTE (LCSW)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:ANTOINETTE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:ANTOINETTE
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:438 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2228
Mailing Address - Country:US
Mailing Address - Phone:312-622-7984
Mailing Address - Fax:
Practice Address - Street 1:438 NORTH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2228
Practice Address - Country:US
Practice Address - Phone:312-622-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490269131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical