Healthcare Provider Details

I. General information

NPI: 1114430758
Provider Name (Legal Business Name): SARAH WATSON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 W BIG BEAVER RD STE C
TROY MI
48084-3540
US

IV. Provider business mailing address

43415 HARTWICK DR
STERLING HEIGHTS MI
48313-1933
US

V. Phone/Fax

Practice location:
  • Phone: 248-509-0503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH WATSON
Title or Position: OWNER
Credential: LPC
Phone: 248-509-0503