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General NPI Number Information
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NPI Number | 1629450770
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Entity Type | Individual
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Provider Name | CHRISTINA MICHELLE WATKINS LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 02/04/2018
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Provider Practice Location Address
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Address Line | 3301 E 12TH ST SUITE 259
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City | OAKLAND
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State | CA
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Zip | 94601-3424
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Country | US
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Telephone | 706-399-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 1074 E 33RD ST APT. A
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City | OAKLAND
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State | CA
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Zip | 94610-4002
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Country | US
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Telephone | 706-399-7447
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ASW67482
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9056
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 73614
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License Number State | CA
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