Provider Demographics
NPI:1073234027
Name:HAWKS, MICHELLE J
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:HAWKS
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 1:166 TOWN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9529
Mailing Address - Country:US
Mailing Address - Phone:336-528-1859
Mailing Address - Fax:
Practice Address - Street 1:154 N RENFRO ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3879
Practice Address - Country:US
Practice Address - Phone:336-528-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health