Healthcare Provider Details

I. General information

NPI: 1023940038
Provider Name (Legal Business Name): MICHAEL DAVID WATTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2167
US

IV. Provider business mailing address

1321 N ADAMS CT APT 306
ARLINGTON VA
22201-5894
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-1512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: