Healthcare Provider Details

I. General information

NPI: 1598140063
Provider Name (Legal Business Name): ORTH & WATSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17869 GARRETT HWY SUITE C
OAKLAND MD
21550-7172
US

IV. Provider business mailing address

17869 GARRETT HWY SUITE C
OAKLAND MD
21550-7172
US

V. Phone/Fax

Practice location:
  • Phone: 240-488-4131
  • Fax: 240-488-4132
Mailing address:
  • Phone: 240-488-4131
  • Fax: 240-488-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE RENE WATSON
Title or Position: MANAGING MEMBER
Credential: MA
Phone: 240-488-4131