Healthcare Provider Details

I. General information

NPI: 1265002935
Provider Name (Legal Business Name): MICHELLE KAYE HAWKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 SHAW RD
MELBER KY
42069-8737
US

IV. Provider business mailing address

293 SHAWN DR
BENTON KY
42025-6763
US

V. Phone/Fax

Practice location:
  • Phone: 270-674-6061
  • Fax:
Mailing address:
  • Phone: 270-519-3821
  • Fax: 270-443-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255648
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: