Healthcare Provider Details

I. General information

NPI: 1477457307
Provider Name (Legal Business Name): NAOMI LEA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MEMORIAL DR STE 100
GREER SC
29650-1517
US

IV. Provider business mailing address

607 STALLINGS RD
TAYLORS SC
29687-6645
US

V. Phone/Fax

Practice location:
  • Phone: 864-451-2563
  • Fax:
Mailing address:
  • Phone: 864-275-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4868
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: