Provider Demographics
NPI:1700507282
Name:HAWKINS, KATHLEEN ELISE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELISE
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 1:1905 WHITE HERON RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6147
Mailing Address - Country:US
Mailing Address - Phone:410-200-0327
Mailing Address - Fax:
Practice Address - Street 1:10605 CONCORD ST STE 207
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2526
Practice Address - Country:US
Practice Address - Phone:410-200-0327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker