Healthcare Provider Details

I. General information

NPI: 1659667616
Provider Name (Legal Business Name): DIANE JONES HAWKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9504 SELBY PL
NORFOLK VA
23503-2913
US

IV. Provider business mailing address

2227 OLD EMMORTON RD SUITE 119
BEL AIR MD
21015-6187
US

V. Phone/Fax

Practice location:
  • Phone: 757-447-4947
  • Fax: 410-569-0094
Mailing address:
  • Phone: 410-569-9497
  • Fax: 410-569-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904005351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: