Provider Demographics
NPI:1992161806
Name:WHITEHAWK, LLC
Entity type:Organization
Organization Name:WHITEHAWK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-365-5249
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-0298
Mailing Address - Country:US
Mailing Address - Phone:860-365-5249
Mailing Address - Fax:860-365-5249
Practice Address - Street 1:26 LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1200
Practice Address - Country:US
Practice Address - Phone:860-365-5249
Practice Address - Fax:860-365-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty