Basic Information
| Provider Information | |||||||||
| NPI: | 1801089479 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMOND | ||||||||
| FirstName: | CHARMAINE | ||||||||
| MiddleName: | WALKER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, APIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 N ENGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479339744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653619767 | ||||||||
| FaxNumber: | 7653610374 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N ENGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479339744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653619767 | ||||||||
| FaxNumber: | 7653610374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 91241 | IN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 200196900A | 05 | IN | MEDICAID |