Provider Demographics
NPI:1962757062
Name:HAMILTON-GENSON, MICHAEL W (NCC, LPCA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:HAMILTON-GENSON
Suffix:
Gender:M
Credentials:NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5973
Mailing Address - Country:US
Mailing Address - Phone:704-664-7148
Mailing Address - Fax:
Practice Address - Street 1:363 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5973
Practice Address - Country:US
Practice Address - Phone:704-664-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7784101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor