Provider Demographics
NPI:1982390001
Name:HAWKINS, ASHLEY RAE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
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 1:116 CLUB RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-9448
Mailing Address - Country:US
Mailing Address - Phone:304-502-3143
Mailing Address - Fax:
Practice Address - Street 1:116 CLUB RIDGE DR
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9448
Practice Address - Country:US
Practice Address - Phone:304-502-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician