Provider Demographics
NPI:1114377603
Name:HAWKINS, MICHAEL (CSAC, NCAC II)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:CSAC, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 PLANK RD
Mailing Address - Street 2:6C
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6861
Mailing Address - Country:US
Mailing Address - Phone:703-975-2315
Mailing Address - Fax:540-412-0223
Practice Address - Street 1:3516 PLANK RD
Practice Address - Street 2:6C
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6861
Practice Address - Country:US
Practice Address - Phone:703-975-2315
Practice Address - Fax:540-412-0223
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102682101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)