MEDICARE: MICHAEL HAWKINS CSAC, NCAC 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102682	VA

General Provider Information

NPI Number	:	1114377603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HAWKINS CSAC, NCAC II

Provider Business Mailing Address
First Line	:	3516 PLANK RD
Second Line	:	6C
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6861
Country	:	US
Telephone Number	:	703-975-2315
Fax Number	:	540-412-0223

Provider Business Practice Location Address
First Line	:	3516 PLANK RD
Second Line	:	6C
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6861
Country	:	US
Telephone Number	:	703-975-2315
Fax Number	:	540-412-0223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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