Provider Demographics
NPI:1578184982
Name:HAWKINS, CHARLEY MARISSA (BCBA)
Entity type:Individual
Prefix:
First Name:CHARLEY
Middle Name:MARISSA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHARLEY
Other - Middle Name:MARISSA
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2440
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71914-2440
Mailing Address - Country:US
Mailing Address - Phone:501-620-6619
Mailing Address - Fax:
Practice Address - Street 1:407 CARSON ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6852
Practice Address - Country:US
Practice Address - Phone:501-620-6619
Practice Address - Fax:501-624-1176
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AR1-24-76649103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR274145706Medicaid