Provider Demographics
NPI:1740348697
Name:HAWKINS, DOUGLAS KENT (EDD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KENT
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 12TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3279
Mailing Address - Country:US
Mailing Address - Phone:304-232-3464
Mailing Address - Fax:304-232-3328
Practice Address - Street 1:40 12TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3279
Practice Address - Country:US
Practice Address - Phone:304-232-3464
Practice Address - Fax:304-232-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV386103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHY00386OtherHEALTH PLAN UPPER OH VALL
MN1102977OtherCIGNA BEHAVIOR HEALTH, IN
WV0163933000Medicaid
WV4033551Medicare ID - Type Unspecified