Provider Demographics
NPI:1659730133
Name:HAWTHORNE INTEGRATIVE
Entity Type:Organization
Organization Name:HAWTHORNE INTEGRATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:FLAUM
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPCC-S
Authorized Official - Phone:937-545-7392
Mailing Address - Street 1:5450 FAR HILLS AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2386
Mailing Address - Country:US
Mailing Address - Phone:937-545-7392
Mailing Address - Fax:
Practice Address - Street 1:5450 FAR HILLS AVE STE 222
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2386
Practice Address - Country:US
Practice Address - Phone:937-545-7392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE7537101YM0800X
OHE2080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty