Provider Demographics
NPI:1609269828
Name:HAWKINS, AYESHA TREACHEA (MS-HUMAN BEHAVIOR)
Entity Type:Individual
Prefix:MRS
First Name:AYESHA
Middle Name:TREACHEA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MS-HUMAN BEHAVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 JACKYBELL TRL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6350
Mailing Address - Country:US
Mailing Address - Phone:470-253-5529
Mailing Address - Fax:
Practice Address - Street 1:4645 JACKYBELL TRL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6350
Practice Address - Country:US
Practice Address - Phone:470-253-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X, 103TE1100X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
473298455OtherTAX ID NUMBER