Provider Demographics
NPI:1942500996
Name:HAWKINS, ROMA DEE (LCSW 28701)
Entity Type:Individual
Prefix:MS
First Name:ROMA
Middle Name:DEE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LCSW 28701
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 STANGER AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5523
Mailing Address - Country:US
Mailing Address - Phone:208-681-4578
Mailing Address - Fax:
Practice Address - Street 1:1135 STANGER AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5523
Practice Address - Country:US
Practice Address - Phone:208-681-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID287011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical