Provider Demographics
NPI:1528551397
Name:HAWKINS, TASIA WYNETTE
Entity Type:Individual
Prefix:
First Name:TASIA
Middle Name:WYNETTE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASIA
Other - Middle Name:WYNETTE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 ARIEL CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4433
Mailing Address - Country:US
Mailing Address - Phone:919-744-5882
Mailing Address - Fax:
Practice Address - Street 1:3824 BARRETT DR STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7220
Practice Address - Country:US
Practice Address - Phone:919-790-7775
Practice Address - Fax:919-790-9755
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health