Provider Demographics
NPI:1376810507
Name:HAWKINS, JOHN DOUGLAS JR (MS, LMHC, CA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:HAWKINS
Suffix:JR
Gender:M
Credentials:MS, LMHC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GATEWAY BLVD. STE 104
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-714-3895
Mailing Address - Fax:
Practice Address - Street 1:1034 GATEWAY BLVD. STE 104
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-714-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health