Provider Demographics
NPI:1730438136
Name:HAWKINS, LEE-ANN
Entity type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:
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 1:11414 RHODENDA AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4738
Mailing Address - Country:US
Mailing Address - Phone:301-312-2779
Mailing Address - Fax:301-420-1972
Practice Address - Street 1:7610 PENNSYLVANIA AVE
Practice Address - Street 2:203
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4701
Practice Address - Country:US
Practice Address - Phone:301-420-1972
Practice Address - Fax:301-420-1973
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional