Healthcare Provider Details

I. General information

NPI: 1710361373
Provider Name (Legal Business Name): MS. MADELINE LISA HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

IV. Provider business mailing address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-1040
  • Fax: 864-241-8189
Mailing address:
  • Phone: 864-241-1040
  • Fax: 864-241-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: