Provider Demographics
NPI:1891332722
Name:BLAKE HAWKE, JESSICA ANNE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BLAKE HAWKE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5237 RIVER RD # 278
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1415
Mailing Address - Country:US
Mailing Address - Phone:240-433-3583
Mailing Address - Fax:
Practice Address - Street 1:5237 RIVER RD # 278
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-1415
Practice Address - Country:US
Practice Address - Phone:240-433-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22568104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker