Provider Demographics
NPI:1669948899
Name:HAWK, CHRISTOPHER CLARK (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CLARK
Last Name:HAWK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581074
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1074
Mailing Address - Country:US
Mailing Address - Phone:435-659-9294
Mailing Address - Fax:
Practice Address - Street 1:120 S 100 W
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1509
Practice Address - Country:US
Practice Address - Phone:435-659-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5331963-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical