Healthcare Provider Details

I. General information

NPI: 1356443121
Provider Name (Legal Business Name): DEWEY DEWAYNE WATKINS MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 LT EUGENE J MAJURE DR
PASCAGOULA MS
39581-5305
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-696-9224
  • Fax: 228-696-9228
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1285
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: