Provider Demographics
NPI:1376913475
Name:HAWK, CYNTHIA (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 SUN VALLEY DR STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2178
Mailing Address - Country:US
Mailing Address - Phone:573-616-3007
Mailing Address - Fax:573-616-3008
Practice Address - Street 1:210 HOOVER ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0800
Practice Address - Country:US
Practice Address - Phone:573-632-4321
Practice Address - Fax:573-632-4324
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014042825101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health