Provider Demographics
NPI:1538893615
Name:HAWKINS, STACIE ANN (MS, LMHC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W BROADWAY CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1913
Mailing Address - Country:US
Mailing Address - Phone:765-603-8756
Mailing Address - Fax:
Practice Address - Street 1:1649 W BROADWAY CT
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1913
Practice Address - Country:US
Practice Address - Phone:765-603-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003169A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health