Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1357500819 | CA |
NPI | 1003430398 |
---|---|
Provider Name | Krystal Hawkins |
First Address | Camino, CA 95709-0586 |
Second Address | Camino, CA 95709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 05/06/2020 |