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1578184982 NPI number — CHARLEY MARISSA HAWKINS BCBA

NPI Number: 1578184982
Health Care Provider/Practitioner: CHARLEY MARISSA HAWKINS BCBA

Information about “1578184982” NPI (CHARLEY MARISSA HAWKINS BCBA) exists in 1578184982 in HTML format HTML  |  1578184982 in plain Text format TXT  |  1578184982 in PDF (Portable Document Format) PDF  |  1578184982 in an XML format XML  formats.

NPI Number : 1578184982 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578184982",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HAWKINS",
    "FirstName": "CHARLEY",
    "MiddleName": "MARISSA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GALLOWAY",
    "OtherFirstName": "CHARLEY",
    "OtherMiddleName": "MARISSA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 2440",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOT SPRINGS",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "71914-2440",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-620-6619",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "407 CARSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOT SPRINGS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71901-6852",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "501-620-6619",
    "PracticeLocationAddressFaxNumber": "501-624-1176",
    "EnumerationDate": "04/27/2020",
    "LastUpdateDate": "11/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-24-76649",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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