=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104338235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDI LEANN WATTS M.ED. COUNSELING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2017
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 MAIN STREET
-----------------------------------------------------
City | CHAPMANVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-855-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 BLUE RIDGE RD
-----------------------------------------------------
City | CHAPMANVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25508-5821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-946-7692
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2349
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------