Provider Demographics
NPI:1912563511
Name:HAWKINS, KAMICHA CHARISSE
Entity Type:Individual
Prefix:
First Name:KAMICHA
Middle Name:CHARISSE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CONNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2407
Mailing Address - Country:US
Mailing Address - Phone:313-727-7828
Mailing Address - Fax:
Practice Address - Street 1:2900 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-727-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist