Provider Demographics
NPI:1821338161
Name:HAWKINS, RANDI (MS, MFT-I)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:RIEDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:34662 ELMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6842
Mailing Address - Country:US
Mailing Address - Phone:909-803-4055
Mailing Address - Fax:
Practice Address - Street 1:34324 YUCAIPA BLVD
Practice Address - Street 2:SUITE B-D
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2496
Practice Address - Country:US
Practice Address - Phone:909-790-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist