Healthcare Provider Details

I. General information

NPI: 1538412853
Provider Name (Legal Business Name): KIMBERLY WATZMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 OLD 13 MILE RD
WARREN MI
48093-8700
US

IV. Provider business mailing address

6549 TOWN CENTER DR SUITE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 586-825-9700
  • Fax: 586-825-9701
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401006672
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: