Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0810001126 | VA |
Y | 103G00000X | Clinical Psychologist | 0810001126 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810001126 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810001126 | VA |
NPI | 1053452078 |
---|---|
Provider Name | Dr. John L Hawley JR. |
First Address | Potomac Falls, VA 20165-5827 |
Second Address | Sterling, VA 20165-6146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2007 |
Last Update Date | 06/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214975 | ANTHEM BCBS (01) | VA |
452614 | MAMSI UNITEDHEALTHCARE (01) | VA |
7713649 | (05) | VA |