Provider Demographics
NPI:1497234587
Name:HAWKINS, MICHAEL ANTHONY (OWNER)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 OLD NAPLES RD STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-8613
Mailing Address - Country:US
Mailing Address - Phone:828-684-2445
Mailing Address - Fax:828-684-2443
Practice Address - Street 1:170 OLD NAPLES RD STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8613
Practice Address - Country:US
Practice Address - Phone:828-684-2445
Practice Address - Fax:828-684-2443
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11277A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health