Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | E0700446 | OH |
NPI | 1003067208 |
---|---|
Provider Name | Mr. Lucas Alan Hawkins |
First Address | Columbus, OH 43271-5194 |
Second Address | Columbus, OH 43215-5384 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 15/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08258 | (05) | OH |