Provider Demographics
NPI:1477833168
Name:HAWKINS, LESLIE ANN (PSYD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 TERRAPIN PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-5443
Mailing Address - Country:US
Mailing Address - Phone:757-718-3613
Mailing Address - Fax:
Practice Address - Street 1:9840 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3909
Practice Address - Country:US
Practice Address - Phone:703-547-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366591562Medicaid