Provider Demographics
NPI:1659098887
Name:HAWKINS, KRISTINE ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 S SILVER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7536
Mailing Address - Country:US
Mailing Address - Phone:573-334-1100
Mailing Address - Fax:573-651-4345
Practice Address - Street 1:103 EL NATHAN DRIVE
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-6376
Practice Address - Country:US
Practice Address - Phone:573-238-1027
Practice Address - Fax:573-238-1171
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490116762Medicaid