Provider Demographics
NPI:1710079629
Name:HAWBAKER, MICHELLE M (LPC, LCMHCS, CCS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HAWBAKER
Suffix:
Gender:F
Credentials:LPC, LCMHCS, CCS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:HAWBAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCAS
Mailing Address - Street 1:555 BELAIRE AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4789
Mailing Address - Country:US
Mailing Address - Phone:804-207-6737
Mailing Address - Fax:
Practice Address - Street 1:555 BELAIRE AVE STE 350
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4789
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-1992101YA0400X
NCCCS-13381101YA0400X
NCS4898101YM0800X, 101YP2500X
VA0701009036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017707280001Medicaid
NC6103169Medicaid
MDLCO383OtherSTATE LICENSE MD
VA0701009036OtherSTATE LICENSE VA
NC4898OtherSTATE LICENSE NC