Provider Demographics
NPI:1851465892
Name:HAWKES, BARBARA DERRICK (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:DERRICK
Last Name:HAWKES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 CARRIAGE HOUSE DR STE F
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2254
Mailing Address - Country:US
Mailing Address - Phone:731-664-1922
Mailing Address - Fax:731-664-0779
Practice Address - Street 1:378 CARRIAGE HOUSE DR STE F
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2254
Practice Address - Country:US
Practice Address - Phone:731-664-1922
Practice Address - Fax:731-664-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNLSW35551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3925625Medicaid
TN4035054OtherBLUECROSS BLUESHIELD
TN4035054OtherBLUECROSS BLUESHIELD