Doctor Name: | WILLIE WATSON |
NPI Number: | 1689879140 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | PC-0000409 |
Business Practice Address: | 25 S Old Baltimore Pike Lafayette Bldg. Ii, Suite 400 Christiana, DE - 197021540 |
Business Phone Number: | 3023687453 |
Business Fax Number: | |
Mailing Address: | 5 Cordrey Rd, NEWARK |
State: | DE |
Postal Code: | 197132312 |
Phone Number: | 3023684431 |
Fax Number: | |
NPI Enumeration Date: | 06/15/2007 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC-0000409 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |