Healthcare Provider Details

I. General information

NPI: 1669047643
Provider Name (Legal Business Name): DONALEE WATSON-DWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONALEE WATSON

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 LESTER ST
SILVER SPRING MD
20902-3761
US

IV. Provider business mailing address

10745 LESTER ST
SILVER SPRING MD
20902-3761
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP11491
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13830
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: