Basic Information
| Provider Information | |||||||||
| NPI: | 1942718549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | VANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 RICHARD ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719134805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013187893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 MAIN ST STE V | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719134964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013218200 | ||||||||
| FaxNumber: | 5013218202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P1412118 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | P1412118 | 01 | AR | COUNSELING LICENSE | OTHER |