Provider Demographics
NPI:1437537230
Name:HAWKS, HAROLD DONALD JR (MA, MDIV)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:DONALD
Last Name:HAWKS
Suffix:JR
Gender:M
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT SIDNEY
Mailing Address - State:VA
Mailing Address - Zip Code:24467-2505
Mailing Address - Country:US
Mailing Address - Phone:540-248-0409
Mailing Address - Fax:
Practice Address - Street 1:35 MEADOW LN
Practice Address - Street 2:
Practice Address - City:MOUNT SIDNEY
Practice Address - State:VA
Practice Address - Zip Code:24467-2505
Practice Address - Country:US
Practice Address - Phone:540-248-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001280101YP2500X
FLMT 25106H00000X
VA0717000130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist