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General NPI Number Information
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NPI Number | 1053890020
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Entity Type | Organization
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Legal Business Name | ROBERT HAWKINS COMMUNITY COUNSELING SERVICES
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 350 E DESERT INN RD UNIT E103
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City | LAS VEGAS
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State | NV
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Zip | 89109-9004
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Country | US
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Telephone | 323-682-3045
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Fax |
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Provider Business Mailing Address
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Address Line | 350 E DESERT INN RD UNIT E103
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City | LAS VEGAS
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State | NV
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Zip | 89109-9004
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Country | US
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Telephone | 323-682-3045
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACQUELINE M ANTHONY
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Credential | LMFT
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Telephone | 323-682-3045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01522
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License Number State | NV
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