Provider Demographics
NPI:1053890020
Name:ROBERT HAWKINS COMMUNITY COUNSELING SERVICES
Entity type:Organization
Organization Name:ROBERT HAWKINS COMMUNITY COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-682-3045
Mailing Address - Street 1:350 E DESERT INN RD UNIT E103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-9004
Mailing Address - Country:US
Mailing Address - Phone:323-682-3045
Mailing Address - Fax:
Practice Address - Street 1:350 E DESERT INN RD UNIT E103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-9004
Practice Address - Country:US
Practice Address - Phone:323-682-3045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty