Individual
TRACI DIANE HAMILTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2026
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2026
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-23-2637
OR
101YM0800X
Mental Health Counselor
24-QMHA-I-004507
OR
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/07/2018
Last updated
07/24/2024
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