Provider Demographics
NPI:1558690362
Name:HAWKINS, ETHEL LAURETTA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:LAURETTA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 SEA PINES DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3125
Mailing Address - Country:US
Mailing Address - Phone:301-350-0353
Mailing Address - Fax:301-350-0353
Practice Address - Street 1:10215 SEA PINES DR
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-3125
Practice Address - Country:US
Practice Address - Phone:301-350-0353
Practice Address - Fax:301-350-0353
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC774101YP2500X
DCLC3008701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional