Provider Demographics
NPI:1366912487
Name:HAMILTON-DEMAREE, BLONZETTA LAVERNE
Entity type:Individual
Prefix:
First Name:BLONZETTA
Middle Name:LAVERNE
Last Name:HAMILTON-DEMAREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W BYRD ST
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1405
Mailing Address - Country:US
Mailing Address - Phone:859-231-3747
Mailing Address - Fax:
Practice Address - Street 1:215 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2638
Practice Address - Country:US
Practice Address - Phone:859-231-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor