Provider Demographics
NPI:1841903473
Name:HAWKINS, LA'TREVIA CONDEEJA
Entity type:Individual
Prefix:
First Name:LA'TREVIA
Middle Name:CONDEEJA
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 1:1220 AUGUSTA DR STE 290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2263
Mailing Address - Country:US
Mailing Address - Phone:713-428-8700
Mailing Address - Fax:
Practice Address - Street 1:1220 AUGUSTA DR STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2263
Practice Address - Country:US
Practice Address - Phone:713-428-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28799104100000X
VA903003384104100000X
TX67557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0094Medicaid
TX2717Medicaid
MD3302Medicaid