Healthcare Provider Details

I. General information

NPI: 1093166324
Provider Name (Legal Business Name): DANIEL E WATFORD JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE CARL R. DARNALL ARMY MEDICAL CENTER
FORT HOOD TX
76544
US

IV. Provider business mailing address

36065 SANTA FE AVE CARL R. DARNALL ARMY MEDICAL CENTER
FORT HOOD TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 254-287-1126
  • Fax:
Mailing address:
  • Phone: 254-287-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010148
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: