Provider Demographics
NPI:1649548603
Name:HAWKINS, CHANTELL BREON
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:BREON
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N MARTIN LUTHER KING
Mailing Address - Street 2:208
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-265-7651
Mailing Address - Fax:702-685-7408
Practice Address - Street 1:3925 N MARTIN LUTHER KING
Practice Address - Street 2:208
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-265-7651
Practice Address - Fax:702-685-7408
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst