Provider Demographics
NPI:1205558608
Name:MICHAEL HAWKINS THERAPY, PLLC
Entity type:Organization
Organization Name:MICHAEL HAWKINS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ZOLLIE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-296-3568
Mailing Address - Street 1:6436 ROOSEVELT RD APT 403
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2166
Mailing Address - Country:US
Mailing Address - Phone:708-296-3568
Mailing Address - Fax:
Practice Address - Street 1:6436 ROOSEVELT RD APT 403
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2166
Practice Address - Country:US
Practice Address - Phone:708-296-3568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty