Provider Demographics
NPI:1750408035
Name:HAWKINS-GUNN, KRISTA (MA, LLMSW, CAAC,ICRC)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:
Last Name:HAWKINS-GUNN
Suffix:
Gender:F
Credentials:MA, LLMSW, CAAC,ICRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29530 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5220
Mailing Address - Country:US
Mailing Address - Phone:248-200-7696
Mailing Address - Fax:
Practice Address - Street 1:29530 BERMUDA LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5220
Practice Address - Country:US
Practice Address - Phone:248-200-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020834101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical