Provider Demographics
NPI:1508200759
Name:HAWKINS, JOHN DOUGLAS SR (DD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:HAWKINS
Suffix:SR
Gender:M
Credentials:DD, MS
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
Mailing Address - Street 2:STE. 104
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8369
Mailing Address - Country:US
Mailing Address - Phone:561-797-0631
Mailing Address - Fax:
Practice Address - Street 1:1034 GATEWAY BLVD
Practice Address - Street 2:STE. 104
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8369
Practice Address - Country:US
Practice Address - Phone:561-797-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10291101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist