Healthcare Provider Details

I. General information

NPI: 1811755416
Provider Name (Legal Business Name): DALICIA WATSON LICSW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 SAINT MARKS RD
GADSDEN SC
29052-9618
US

IV. Provider business mailing address

1531 SAINT MARKS RD
GADSDEN SC
29052-9618
US

V. Phone/Fax

Practice location:
  • Phone: 803-348-2366
  • Fax:
Mailing address:
  • Phone: 803-348-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19138
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: