Healthcare Provider Details

I. General information

NPI: 1275594582
Provider Name (Legal Business Name): JEANNE WATSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MAIN ST SUITE A
HILLSVILLE VA
24343-1435
US

IV. Provider business mailing address

PO BOX 100
HILLSVILLE VA
24343-0100
US

V. Phone/Fax

Practice location:
  • Phone: 276-730-0548
  • Fax: 276-730-0568
Mailing address:
  • Phone: 276-730-0548
  • Fax: 276-730-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000999
License Number StateVA

VIII. Authorized Official

Name: JEANNE WATSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: PH.D.
Phone: 276-730-0548