Healthcare Provider Details

I. General information

NPI: 1952986226
Provider Name (Legal Business Name): ANGELIQUE HAWKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N ESTRELLA PKWY STE B2 #447
GOODYEAR AZ
85338-4136
US

IV. Provider business mailing address

500 N ESTRELLA PKWY STE B2
GOODYEAR AZ
85338-4136
US

V. Phone/Fax

Practice location:
  • Phone: 602-661-0200
  • Fax: 602-626-0540
Mailing address:
  • Phone: 602-661-0200
  • Fax: 602-626-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: