Healthcare Provider Details

I. General information

NPI: 1427988591
Provider Name (Legal Business Name): AJAHNIQUE WATTS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 MARINA VILLAGE PKWY # 673
ALAMEDA CA
94501-1048
US

IV. Provider business mailing address

909 MARINA VILLAGE PKWY # 673
ALAMEDA CA
94501-1048
US

V. Phone/Fax

Practice location:
  • Phone: 510-359-8109
  • Fax:
Mailing address:
  • Phone: 510-359-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: