Provider Demographics
NPI:1174761639
Name:HAWKES, VANESSA (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:HAWKES
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 ROYAL FERN WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1163
Mailing Address - Country:US
Mailing Address - Phone:410-298-8046
Mailing Address - Fax:410-496-8074
Practice Address - Street 1:837 WASHINGTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2324
Practice Address - Country:US
Practice Address - Phone:410-298-8046
Practice Address - Fax:410-496-8074
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO869101YA0400X, 101YM0800X, 101YP2500X, 101YS0200X, 106H00000X
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist