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NPI Code Detail

MEDICARE: KRYSTAL HAWKINS CADC II

MEDICARE: KRYSTAL HAWKINS CADC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1373H00000XDay Training/Habilitation SpecialistCA
2101YA0400XAddiction (Substance Use Disorder) Counselor
3101YA0400XAddiction (Substance Use Disorder) CounselorR1357500819CA
4372600000XAdult CompanionCA

General Provider Information

NPI Number : 1003430398
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL HAWKINS CADC II
Provider Business Mailing Address
First Line : 643 PEARL PL APT 4
Second Line :
City : DIAMOND SPRINGS
State : CA
Zip : 95619-9226
Country : US
Telephone Number : 916-539-1604
Fax Number :
Provider Business Practice Location Address
First Line : 8912 VOLUNTEER LN
Second Line :
City : SACRAMENTO
State : CA
Zip : 95826-3221
Country : US
Telephone Number : 916-539-1604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2020
Last Update Date : 03/04/2026

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