Basic Information
| Provider Information | |||||||||
| NPI: | 1881172104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 VIOLA SIPE DR | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1828256343 | ||||||||
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| Practice Location | |||||||||
| Address1: | 929 15TH ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286014162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283276026 | ||||||||
| FaxNumber: | 8283278796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2018 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | P012821 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | P012821 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.