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General NPI Number Information
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NPI Number | 1790885242
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Entity Type | Organization
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Legal Business Name | DENISE HAWKINSON, PH.D., PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4225 EXECUTIVE SQ #1110
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City | LA JOLLA
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State | CA
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Zip | 92037-9122
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Country | US
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Telephone | 858-558-8535
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Fax |
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Provider Business Mailing Address
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Address Line | 5980 CAMINO DE LA COSTA
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City | LA JOLLA
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State | CA
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Zip | 92037-6550
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Country | US
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Telephone | 858-459-6833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE LYNN HAWKINSON
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Credential | PH.D.
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Telephone | 619-991-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20511
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License Number State | CA
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