Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 003303 | GA |
NPI | 1003827627 |
---|---|
Provider Name | Ms. Carla D Hawkins |
First Address | Stone Mountain, GA 30083-3483 |
Second Address | Stone Mountain, GA 30083-3483 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205339263A | (05) | GA |