Provider Demographics
NPI:1891671087
Name:HAWTHORNE LEGACY ENTERPRISES
Entity type:Organization
Organization Name:HAWTHORNE LEGACY ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW, LCSW
Authorized Official - Phone:443-740-0814
Mailing Address - Street 1:113 SWARTHMORE DR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 WEST RD STE 202A
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2318
Practice Address - Country:US
Practice Address - Phone:443-740-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)