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NPI Code Detail

MEDICARE: ALTOVISE RENEE HAWKINS B.S., QMHS

MEDICARE: ALTOVISE RENEE HAWKINS B.S., QMHS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.166446OH

General Provider Information

NPI Number : 1871006015
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTOVISE RENEE HAWKINS B.S., QMHS
Provider Business Mailing Address
First Line : 12395 MCCRACKEN RD
Second Line :
City : GARFIELD HTS
State : OH
Zip : 44125-2967
Country : US
Telephone Number : 216-587-6727
Fax Number :
Provider Business Practice Location Address
First Line : 12395 MCCRACKEN RD
Second Line :
City : GARFIELD HTS
State : OH
Zip : 44125-2967
Country : US
Telephone Number : 216-587-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2017
Last Update Date : 03/14/2018

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