Healthcare Provider Details

I. General information

NPI: 1639576333
Provider Name (Legal Business Name): CHASITY LEANNE HAWKINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 SERVICE RD
RUIDOSO NM
88345-6063
US

IV. Provider business mailing address

237 SERVICE RD
RUIDOSO NM
88345-6063
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-2368
  • Fax: 575-257-2141
Mailing address:
  • Phone: 575-257-2368
  • Fax: 575-257-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number361645
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: