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General NPI Number Information
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NPI Number | 1275594582
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Entity Type | Organization
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Legal Business Name | JEANNE WATSON
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 408 N MAIN ST SUITE A
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City | HILLSVILLE
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State | VA
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Zip | 24343-1435
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Country | US
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Telephone | 276-730-0548
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Fax | 276-730-0568
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | HILLSVILLE
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State | VA
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Zip | 24343-0100
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Country | US
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Telephone | 276-730-0548
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Fax | 276-730-0568
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JEANNE WATSON
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Credential | PH.D.
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Telephone | 276-730-0548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701000999
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License Number State | VA
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