Healthcare Provider Details

I. General information

NPI: 1710547237
Provider Name (Legal Business Name): ROCHELLE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9846 LORI RD
CHESTERFIELD VA
23832-6695
US

IV. Provider business mailing address

9846 LORI RD STE 201
CHESTERFIELD VA
23832-6695
US

V. Phone/Fax

Practice location:
  • Phone: 804-419-4122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: