Healthcare Provider Details

I. General information

NPI: 1205473360
Provider Name (Legal Business Name): KEONNA M WATSON DSOCSCI, MS, BCHHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEONNA M FREEMAN DSOCSCI, MS, BCHHP

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 NEW CASTLE AVE STE 3
NEW CASTLE DE
19720-2174
US

IV. Provider business mailing address

411 ROLLING GREEN AVE
NEW CASTLE DE
19720-4791
US

V. Phone/Fax

Practice location:
  • Phone: 302-277-7161
  • Fax: 302-566-2853
Mailing address:
  • Phone: 302-277-7161
  • Fax: 302-566-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: