Provider Demographics
NPI:1164776118
Name:HAWKS, ZACKARY TERRY (MA)
Entity Type:Individual
Prefix:MR
First Name:ZACKARY
Middle Name:TERRY
Last Name:HAWKS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 RABBIT HILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5484
Mailing Address - Country:US
Mailing Address - Phone:336-710-0046
Mailing Address - Fax:
Practice Address - Street 1:414 W LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2954
Practice Address - Country:US
Practice Address - Phone:336-789-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional