Provider Demographics
NPI:1083010508
Name:HAWKINS, BRIAN S (MSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MRS
Other - First Name:TIJUANA
Other - Middle Name:N
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1005 BLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3386
Mailing Address - Country:US
Mailing Address - Phone:757-572-7206
Mailing Address - Fax:
Practice Address - Street 1:1005 BLAND ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-3386
Practice Address - Country:US
Practice Address - Phone:757-572-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2090-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities