Healthcare Provider Details

I. General information

NPI: 1558793729
Provider Name (Legal Business Name): STERLING P. WATSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 RIVER DR
COLUMBIA SC
29201-1749
US

IV. Provider business mailing address

2611 RIVER DR
COLUMBIA SC
29201-1749
US

V. Phone/Fax

Practice location:
  • Phone: 773-220-9446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1058
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1058
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: