Provider Demographics
NPI:1962831263
Name:HAWES, JENNIFER DIONE KOGER (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIONE KOGER
Last Name:HAWES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DIONE
Other - Last Name:KROGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 S POPLAR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6017
Mailing Address - Country:US
Mailing Address - Phone:501-279-9220
Mailing Address - Fax:501-279-9450
Practice Address - Street 1:403 S POPLAR ST
Practice Address - Street 2:SUITE A
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6017
Practice Address - Country:US
Practice Address - Phone:501-279-9220
Practice Address - Fax:501-279-9450
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1310128101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor