Provider Demographics
NPI:1386813061
Name:HAWKINS, BRUCE W (MA, LPC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3787
Mailing Address - Country:US
Mailing Address - Phone:517-266-8880
Mailing Address - Fax:517-266-8881
Practice Address - Street 1:738 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3787
Practice Address - Country:US
Practice Address - Phone:517-266-8880
Practice Address - Fax:517-266-8881
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004232101YP2500X
MI6802062829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30294Medicaid