Healthcare Provider Details

I. General information

NPI: 1487977013
Provider Name (Legal Business Name): ANDREA R WATTS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8341 WASHINGTON ST NE
ALBUQUERQUE NM
87113-1607
US

IV. Provider business mailing address

804 PALOMAS DR NE
ALBUQUERQUE NM
87108-1632
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5499
  • Fax:
Mailing address:
  • Phone: 505-362-4131
  • Fax: 505-820-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0179621
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: