Healthcare Provider Details

I. General information

NPI: 1588908321
Provider Name (Legal Business Name): CAROL L WATKINS MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 3RD ST
LA MESA CA
91941-5558
US

IV. Provider business mailing address

4508 3RD ST
LA MESA CA
91941-5558
US

V. Phone/Fax

Practice location:
  • Phone: 619-889-1238
  • Fax:
Mailing address:
  • Phone: 619-889-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 37103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: