Provider Demographics
NPI:1346500287
Name:HAWKINS, AMANDA C (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:C
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57505 COUNTY ROAD U 60
Mailing Address - Street 2:
Mailing Address - City:MOFFAT
Mailing Address - State:CO
Mailing Address - Zip Code:81143
Mailing Address - Country:US
Mailing Address - Phone:719-850-2523
Mailing Address - Fax:
Practice Address - Street 1:57505 COUNTY ROAD U 60
Practice Address - Street 2:
Practice Address - City:MOFFAT
Practice Address - State:CO
Practice Address - Zip Code:81143-9760
Practice Address - Country:US
Practice Address - Phone:719-850-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0477723101Y00000X, 101YS0200X
101YM0800X, 103TA0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral