Healthcare Provider Details

I. General information

NPI: 1538076518
Provider Name (Legal Business Name): CAROL LOUISE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W HANOVER RD
GRAHAM NC
27253-1721
US

IV. Provider business mailing address

101 W HANOVER RD
GRAHAM NC
27253-1721
US

V. Phone/Fax

Practice location:
  • Phone: 336-708-4535
  • Fax:
Mailing address:
  • Phone: 336-708-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: