Provider Demographics
NPI:1972936185
Name:HAWKINS, LAURESHA ZINATAE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURESHA
Middle Name:ZINATAE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 THE RESORT PKWY UNIT 7614
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9255
Mailing Address - Country:US
Mailing Address - Phone:951-441-4076
Mailing Address - Fax:
Practice Address - Street 1:9350 THE RESORT PKWY
Practice Address - Street 2:UNIT 7614
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9255
Practice Address - Country:US
Practice Address - Phone:951-441-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1162281041C0700X, 1041C0700X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770356677OtherPRIVATE PRACTICE