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General NPI Number Information
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NPI Number | 1134879976
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Entity Type | Individual
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Provider Name | CANDICE SIMONE WATKINS LAC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 130 W WHITE HORSE PIKE STE B
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City | BERLIN
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State | NJ
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Zip | 08009-2028
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Country | US
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Telephone | 347-489-4169
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Fax |
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Provider Business Mailing Address
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Address Line | 606 ABERDEEN LN
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City | BLACKWOOD
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State | NJ
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Zip | 08012-5503
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Country | US
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Telephone | 347-489-4169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37AC00629500
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License Number State | NJ
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