Provider Demographics
NPI:1306312293
Name:HAWKINSON, WILMA MCALVAIN (CADC II)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:MCALVAIN
Last Name:HAWKINSON
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:WILMA
Other - Middle Name:
Other - Last Name:HAWKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:404 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5539
Mailing Address - Country:US
Mailing Address - Phone:541-753-7801
Mailing Address - Fax:
Practice Address - Street 1:404 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5539
Practice Address - Country:US
Practice Address - Phone:541-753-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-06-20064101YA0400X
ORTHW000003007175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1932794575Medicaid