Healthcare Provider Details

I. General information

NPI: 1295915882
Provider Name (Legal Business Name): MARY MAGDALENE WATTS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MAGDALENE FREEMAN M.S.

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 SWEETIE SMITH RD
ASHFORD AL
36312-7422
US

IV. Provider business mailing address

2694 S PARK AVE
DOTHAN AL
36301-4904
US

V. Phone/Fax

Practice location:
  • Phone: 334-690-8030
  • Fax: 334-691-8029
Mailing address:
  • Phone: 334-712-2720
  • Fax: 334-712-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: